Intracranial hemorrhage. There is predominantly intermediate T1 and high T2 signal left parieto-occipital intraparenchymal hematoma that measures up to approximately 3 cm. Mild surrounding restricted diffusion may be related to susceptibility from blood products and/or mild acute ischemia. There is extensive bilateral cerebral white matter T2 hyperintensity predominately in a periventricular distribution, without restricted diffusion. There is also a punctate focus of high T2 signal in the medial right thalamus. There is patchy susceptibility effect in the left medial temporal lobe. There are also punctate foci of susceptibility effect in the right thalamus, left superior frontal gyrus, and bilateral cerebellar hemispheres. A punctate focus of susceptibility effect in the left occipital lobe anterior to the hematoma may represent an additional microhemorrhage or thrombus within a left posterior cerebral branch artery. There is a right cerebellar hemisphere developmental venous anomaly. There is diffuse cerebral volume loss. There is no midline shift or herniation. The orbits are grossly unremarkable. There is a probable keloid in the right occipital scalp. There are also numerous skin tags in the face. There is a left maxillary sinus retention cyst.
1. An acute left parieto-occipital intraparenchymal hematoma that measures up to approximately 3 cm may be associated with mild surrounding acute ischemia, but no midline shift. 2. Probable chronic right thalamus lacunar infarct and a background of extensive cerebral white matter signal abnormality may represent chronic small vessel ischemic disease.3. Patchy susceptibility effect in the left medial temporal lobe may represent the sequela of a remote hemorrhage, perhaps related to infarction. 4. Punctate foci of susceptibility effect in the right thalamus, left superior frontal gyrus, and bilateral cerebellar hemispheres likely represent chronic microhemorrhages.5. A punctate focus of susceptibility effect in the left occipital lobe anterior to the hematoma may represent an additional microhemorrhage or thrombus within a posterior cerebral branch artery. 6. Right cerebellar hemisphere developmental venous anomaly.Discussed with Dr. Kramer at 10:35 AM on 1/31/16.