 MRI brain: There is a large intracerebral hematoma involving the right temporal, parietal and frontal lobes measuring 8.8 x 5.2 cm in maximum axial dimensions. There is intraventricular hemorrhage with layering hemosiderin levels in the occipital horns as well as blood in the third and fourth ventricle. There is extensive T2 hyperintensity surrounding the lesion consistent with vasogenic edema. There is mass effect with effacement of the right lateral ventricle and subfalcine herniation. There is mild dilatation of the left lateral ventricle. There is midline shift to the left of approximately 9 mm. There is effacement of the cortical sulci on the right side. There are foci of restricted diffusion with associated T2 hyperintensity involving the right paramedian frontal lobe, as well as along the left cingulate gyrus indicating small areas of acute ischemia.In addition 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.The midline structures and craniocervical junction are within normal limits.There is minimal mucosal thickening and small air-fluid levels in the maxillary and sphenoid sinuses, including mucosal thickening in the bilateral ethmoid and left frontal sinuses. MRA brain: There is no evidence of any vascular malformation in the vicinity of the large right cerebral hematoma. There is reduced caliber of the right middle cerebral artery branches likely secondary to mass effect. No aneurysms are detected within the limitations of technique.The intracranial internal carotid arteries are normal in course and caliber. The left middle cerebral artery and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber.
1. Large intracerebral hematoma in the right temporal, parietal and frontal lobes, with extensive intraventricular hemorrhage as demonstrated on previous CT, showing no significant interval change.2. Mass effect on the right ventricle, subfalcine herniation and 9 mm leftward midline shift.3. Small areas of acute ischemia involving the right paramedian frontal lobe and the left cingulate gyrus.4. Periventricular and subcortical hyperintensities compatible with chronic small vessel ischemic disease. 5. No evidence of any vascular malformation is seen in the vicinity of the large hematoma. Reduced caliber of the right middle cerebral artery branches is likely secondary to mass effect.