Evaluate intracranial hemorrhage. Found down, unresponsive. MRI brain: There is stable to slight interval increase in size of a right frontal lobe intraparenchymal hematoma measuring 3.2 x 2.7 cm (AP x TR), previously 3.1 x 2.4 cm, with surrounding edema and mild mass effect. There is a homogeneously enhancing lesion measuring 1.2 x 1.5 x 2.5 cm (AP x TR x CC) at the paramedian right frontal lobe along the cortical surface with questionable associated mineralization hyperostosis on recent CT. This lesion is favored to be extra-axial but possibility of intra-axial location along the cortical surface not entirely excluded. There are foci of susceptibility which may be related to hemorrhage or mineralization.There is restriction diffusion in the right thalamus and the right posterior medial cerebellar hemisphere with corresponding FLAIR hyperintensity.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. No hydrocephalus. There are multiple foci of susceptibility effect within the supratentorial compartment predominantly in a lobar distribution, consistent with hemosiderin deposition from chronic microhemorrhage. Few foci within the left thalamus and bilateral basal ganglia are also noted which may be related to chronic hypertension. There is trace fluid in the right maxillary sinus and nasopharynx. An endotracheal and oroenteric tube are partially imaged. Partial bilateral mastoid air cell opacification also noted.MRA brain: The intracranial internal carotid arteries are normal in course and caliber. No significant stenosis is seen involving the anterior or middle cerebral arteries. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV brain: MRV images are limited by motion degradation. In combination with the postgadolinium sequences there is no convincing evidence of venous sinus thrombosis. The left transverse sinus appears hypoplastic. Cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height and disc desiccation throughout the cervical spine. No worrisome focal marrow signal abnormality is appreciated. No definite cord signal abnormality is appreciated. Degenerative changes are seen as described below:C2-C3: Mild posterior disc osteophyte complex. No significant spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left and mild right foraminal stenosis.C4-C5: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left greater than right foraminal stenosis.C5-C6: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis.C6-C7: Posterior disc osteophyte complex with superimposed central disc extrusion with cranial migration of 10 mm, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and mild left worse than right bilateral foraminal stenosis. There is mass effect on the cord.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis. Disc extrusion is also seen at the T1-T2 level on the sagittal sequences with effacement of the ventral thecal sac.
1. There is stable to slight interval increase in size of a right frontal lobe hematoma measuring up to 3.2 cm with surrounding edema and mild local mass effect. No associated enhancement is definitively appreciated.2. There is a 2.5 cm homogeneously enhancing lesion along the paramedian right frontal lobe which may represent an extra-axial enhancing lesion such as meningioma. However, the possibility that this is a enhancing intra-axial lesion at the cortical surface cannot be entirely excluded. There is associated susceptibility effect which may be related to mineralization versus chronic blood products. Motion degraded postcontrast sequences do not demonstrate additional enhancing masses within the brain. If clinically warranted, the postgadolinium sequences may be repeated with perhaps inclusion of a 3-D T2 sequence to better delineate if this mass is extra-axial or intra-axial in location.3.Multiple foci of susceptibility effect consistent with chronic microhemorrhages involving the bilateral cerebral hemisphere. These are predominantly in the lobar distribution favoring amyloid angiopathy. This may be the etiology of the right frontal lobe hemorrhage. 4. Restriction diffusion in the right thalamus as well as the right posterior medial right cerebellar hemisphere with corresponding FLAIR hyperintensity favored to represent acute to subacute infarcts. There is also evidence of moderate chronic small vessel ischemic disease.5. No evidence of intracranial aneurysm or flow-limiting limiting stenosis. No definite evidence of venous sinus thrombosis.6. Advanced degenerative changes of the cervical spine with moderate spinal canal stenosis and mild cord deformity at C3-4, C4-C5, and C6-C7. No definite cord signal abnormality is appreciated.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.