Follow-up on left intracranial hemorrhage due to melanoma metastasis. The CSF spaces are appropriate for the patient's stated age. There redemonstration of a large left basal ganglia hematoma currently measuring 38 x 43 millimeters which measures similar to the prior exam. It is associated with a satellite foci of hemorrhage in the left inferior frontal gyrus measuring about 10 mm x 9 mm also unchanged since prior exam . It is also Associated with a small amount of intraventricular blood in the lateral ventricles. There is mass effect present with shift of the septum pellucidum approximately 6 mm to the right of midline and the shift of the third ventricle approximately a 3 mm the right of midline. The suprasellar cistern appears intact. Since the previous exam the amount of the vasogenic edema associated with this and a focus of hemorrhage appears to have mildly increased.There is a hyperdense focus present in the left temporal lobe anterior pole measuring 10 mm in diameter on the current exam which was not visible on the previous exam. It could not be identified on an MRI of 10/27 /09 on gradient echo images on the previous exam it measured around this 6 mm in diameter compared there are a couple more hyperdense foci present one in the the right precentral gyrus measures approximately 5 mm in diameter. A couple are present along the pars marginalis bilaterally each measuring about 4 or 5 mm and several are present along the left superior frontal gyrus which are all adjacent to each other. Overall these have been identified on the gradient echo MRI. It can also be identified on prior CT scan . The one zone along the pars marginalis are more conspicuous on the current foramen appearThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the previous examination the edema associated with a large left basal ganglia hematoma has a mildly increased. The midline shift is not substantially different. There may be a difference of a millimeter or two more midline shift on the current versus the prior exam.2.There are multiple foci of hyperdensity scattered in above hemispheres of the brain most of which are identified on the prior exam a two or 3 of them are slightly more conspicuous on the current exam indicating that there may have been a small amount of hemorrhage which has occurred.