Female, 37 years old, with subarachnoid hemorrhage and negative angiogram. Subarachnoid blood product is redemonstrated predominately collected along the ventral brainstem but with some blood product evident in the ventricular system and scattered along the cerebral sulci. The overall quantity and distribution of this blood product is not significantly changed allowing for differences in technique.A right frontal approach ventriculostomy catheter remains in place, tip at the right foramen of Monro. Ventricles remain dilated but to a similar degree as that seen before.T2 hyperintensity and mild encephalomalacia is evident effecting the bilateral paramedian frontal lobes and the left opercular region.The pons and medulla are distorted likely from the effect of substantial adjacent blood product. There is patchy T2 hyperintensity within both the pons and the medulla, and there is a single punctate focus of susceptibility within the parenchyma of the right dorsal pons. Otherwise, no discrete lesion is seen. On postcontrast sequences, there is mild diffuse dural enhancement, likely reactive to hemorrhage and surgical intervention. No definite enhancing lesions are seen within the brainstem, posterior fossa, or in the cerebral hemispheres.
1. Redemonstration of extensive subarachnoid hemorrhage, predominantly along the ventral brainstem but also scattered throughout the cerebral sulci and intraventricularly.2. Patchy signal abnormality is seen through the pons and medulla, and there is a single punctate focus of presumed blood product within the right dorsal pons. However, no definite discrete or enhancing lesion is seen to suggest the etiology for the subarachnoid hemorrhage.3. Persistent ventriculomegaly with a stably positioned right frontal approach ventricular catheter.4. Encephalomalacia involving the bilateral frontal lobes and the left opercular region may reflect remote ischemic injury.