Clinical question: Evaluate for structural lesions, ischemia. Signs and symptoms: Comatose decorticate posturing. Nonenhanced brain MRI:Examination demonstrates a focus of restricted diffusion in the right inferior cerebellum measuring at 8 x 12-mm. Additional focus of restricted diffusion involving the left cerebral peduncle and left thalamus measuring at 20 x 10-mm in transaxial dimensions and consistent with acute ischemic strokes.Additionally examination demonstrate fairly extensive bilateral hemispheric cortical restricted diffusion with resultant cortical flair hyperintensity and effacement of adjacent cortical sulci when compared to the prior study. Shunted lateral ventricles demonstrate acute blood product in their trigone and occipital horns as well as acute parenchymal hematoma along the course of right frontal approach ventricular catheter measuring approximately at 17 x 24-mm in size.There is interval decreased size of ventricular system and with maintained midline.Diffuse flair hyperintensity of bilateral hemispheric white matter, bilateral basal ganglia, thalamus and extensively of the pons similar to prior exam and consistent with advanced chronic nonhemorrhagic small vessel ischemic stroke. Revisualization of a chronic left posterior temporal -- occipital ischemic stroke. The signal voids of major intracranial arterial branches are identified. Aneurysm of the basilar tip measures at 9 x 7-mm in transaxial dimensions (axial T2 series 40 on image 14). The aneurysm on prior study from 3 -- 3 -- 15 on axial T2 series measured at 8.8 x 6.4-mm. On coronal T2-weighted images the transverse diameter the aneurysm measures at 8.7 compared to prior study measurement of 7.9-mm. Although not a dedicated vascular imaging the apparent change in size of aneurysm is suggestive of interval expansion of the aneurysm.
1.Diffusion weighted images demonstrate two distinct foci of restricted diffusion in the right cerebellar and left cerebral peduncle and thalamus without hemorrhage. Diffuse bilateral hemispheric cortical restricted diffusion and with flair hyperintensity and partial effacement of adjacent cortical sulci compared to prior exam. Extensive chronic nonhemorrhagic small vessel ischemic strokes as detailed.2.Interval placement of a right frontal approach ventricular catheter with decreased ventricle since prior. Postprocedural hemorrhage in the ventricular system and a hematoma in the right frontal lobe measuring at 17 x 24-mm.3.The measurements for basilar tip aneurysm both on axial and coronal images suggest subtle interval increased size since prior study as detailed/measured above.