 Again seen is an acute intraparenchymal hematoma in the left paramedian cerebellum that measures approximately 22 x 25 mm with surrounding vasogenic edema. There is also a small hematoma in the right lateral cerebellum also seen on the recent CT.There are multiple additional foci of susceptibility effect in the brain including the bilateral basal ganglia, right thalamus, right subinsular white matter, and right medial temporal lobe, compatible with chronic microhemorrhages.There are areas of restricted diffusion in the left paramedian cerebellum likely related to the acute hemorrhage itself. Otherwise, there is no restricted diffusion in the brain.T2/FLAIR hyperintensities are seen in the subcortical and the periventricular white matter, in the central semiovale, and in the pons, which are nonspecific and likely representing chronic ischemic small vessel disease.There is FLAIR hyperintensity at the level of the left sigmoid sinus which likely represents slow flow with preserved enhancement on the postcontrast sequences.There is mucous retention cyst in the left maxillary sinus with fluid in the nasal cavity.
1. Acute intraparenchymal hematoma involving the left paramedian cerebellum and a smaller focus in the right lateral cerebellar hemisphere as seen on recent CT. There is minimal restricted diffusion associated with the left cerebellar hematoma which is favored to be related to the blood products themselves. No evidence of acute infarct elsewhere in the brain. No abnormal enhancing lesions in the brain.2. Multiple chronic microhemorrhages with a distribution favoring chronic hypertensive etiology.3. Moderate chronic small vessel ischemic disease.