Female, 77 years old, with intracranial hemorrhage. Evaluate for underlying cause. A large parenchymal hemorrhage is redemonstrated in the right cerebral hemisphere measuring up to 82 x 52 x 57 mm. The hemorrhagic cavity has coalesced and has mildly increased in size relative to the prior MRI. Internal signal characteristics are compatible with subacute blood product.The parenchyma surrounding the hemorrhagic cavity is edematous. Generalized mass effect is seen including a midline shift to the left of approximately 10 mm, partial effacement of the right lateral ventricle, subfalcine herniation and generalized sulcal effacement in the right cerebral hemisphere. Mass effect is increased from the prior MRI but is relatively unchanged when compared to more recent CTs.Without the benefit of IV contrast, no definite causative lesion is detected within or adjacent to the hemorrhagic cavity. A few scattered foci of T2 hyperintensity are evident within the cerebral hemispheres, a nonspecific finding. The left lateral ventricle remains mildly dilated suggesting entrapment. No definite evidence of intraventricular blood product is seen. No new intracranial lesions are seen.
A large subacute hematoma is again seen in the right cerebral hemisphere with substantial generalized mass effect. Without the benefit of IV contrast, no definite causative lesion is seen within or adjacent to the hematoma.