90-year-old female with new onset of left body weakness and numbness after fall. Left arm weakness, cramping, and numbness. There are areas of intrinsic T1 and T2 hyperintensity involving the subarachnoid space along the central sulcus on the right consistent with subacute subarachnoid hemorrhage. Areas of T2 hypointensity with more extensive areas of susceptibility in the right parietal sulci are best seen on the SWI sequence. There is minimal local expansion of the right central sulcus related to the blood products. Otherwise no mass or mass effect is seen. No restricted diffusion to suggest acute ischemia. No hydrocephalus. No subdural collections.Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes. Global parenchymal volume loss is noted, commensurate with patient's advanced age.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Subarachnoid hemorrhage involving the right central sulcus and adjacent right parietal lobe sulci. Subarachnoid hemorrhage in the right central sulcus is likely subacute in age with adjacent blood products appearing subacute to chronic. Given the relative peripheral distribution, this hemorrhage may be posttraumatic as indicated by the history.2. No evidence of acute infarct. No intracranial mass or mass effect. No parenchymal or subdural hemorrhage.Dr. Ali discussed findings with Dr. Bernard at 1310 hrs on 7/7/2015.