Diagnosis: Nontraumatic intracerebral hemorrhage in hemisphere, corticalClinical question: assess hematoma status for the MISTIE trial There is redemonstration of a large hematoma measuring 90 cm x 42 cm axial dimensions involving the right basal ganglia and adjacent right centrum semiovale. There is surrounding contrast enhancement and T2 and FLAIR signal change. There is associated mass effect present with shift of the third ventricle 11 mm to the left of midline. There is redemonstration of uncal herniation and mild transtentorial herniation with some displacement of the brainstem towards the left. The left lateral ventricle is mildly enlarged. There is a fluid fluid level present in the left lateral ventricle and the right lateral ventricle compatible with intraventricular blood.There is diffusion restriction evident along the cerebral peduncles bilaterally right more than left. Punctate foci of diffusion restriction are present in the left periventricular white matter.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.Since the prior exam patient has developed new foci of diffusion restriction compatible with infarction along the cerebral peduncles. The patient does have transtentorial herniation associated with compression of the brainstem. 2.There is redemonstration of a large hematoma centered in the right basal ganglia and right centrum semiovale associated with mass effect including uncal and transtentorial herniation as well as intraventricular blood. These findings were also present on the previous exam and continue to evolve.3.Small punctate foci of infarction are present in the periventricular white matter.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.