New gait abnormality and confusion. Recent CT with intratemporal bleed on the left side. A lesion is again noted in the left temporal lobe which contains increased peripheral T1 signal intensity and susceptibility weighted abnormalities measuring 2.6 x 2.0 cm. There is surrounding vasogenic edema which appears similar to the previous exam. Within the limitations of the motion degraded enhanced exam, there is no evidence of abnormal enhancement to indicate an underlying mass and no abnormal surrounding flow voids are appreciated. This lesion corresponds to the intraparenchymal hematoma described on the recent CT from a few days ago, and appears slightly larger taking into account differences in technique. These findings are compatible with an acute to subacute evolving hemorrhage without discrete evidence of an underlying mass. Additional T2/FLAIR hyperintensities in the periventricular, subcortical region as well as within the pons are nonspecific but compatible with moderate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Again seen is a left temporal intraparenchymal hematoma with surrounding vasogenic edema. The hematoma appears slightly larger compared to the noncontrast CT exam from 10/26/2015, with differences in technique limiting comparison. There is mild local mass effect. No underlying mass, abnormal enhancement or abnormal flow voids are noted within the area of hemorrhage. Follow-up MRI may be helpful to assess for underlying lesion once the intraparenchymal hematoma resolves, especially given the motion degradation on the current study.2.No foci of additional hemorrhage or abnormal enhancement are noted elsewhere in the brain.3.Moderate chronic small vessel ischemic disease.