Intracranial hemorrhage with altered mental status. There are postoperative findings related to right PCOM aneurysm coiling and stenting. There is a small amount of scattered subarachnoid hemorrhage and hemorrhage within the ventricular system with evidence of superficial siderosis. There is a predominantly T1 and T2 hyperintense hematoma in the right frontal lobe surrounding the path of the prior right transfrontal ventricular catheter that measures up to approximately 25 mm with surrounding vasogenic edema. There is also a small amount of hemorrhage along the left transfrontal shunt catheter path. The ventricular system appears to be stable to minimally more distended. There are small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter. There is also mild scattered cerebral white matter T2 hyperintensity and more confluent T2 hyperintensity in the periventricular regions. There appears to be a small amount of encephalomalacia in the right cerebellar hemisphere. There is no midline shift or herniation. There is fluid signal within the bilateral mastoid air cells and middle ears.
1. Small amounts of residual scattered subarachnoid hemorrhage and hemorrhage within the ventricular system, with evidence of superficial siderosis. 2. Subacute hemorrhage along the bilateral transfrontal ventricular catheter paths, right larger than left. 3. The shunted ventricular system appears to be stable to minimally more distended.4. Small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter.