Male, 64 years old, with left-sided weakness. Assess for stroke. Signal characteristics of the large left thalamic hematoma have changed in the interval compatible with expected evolution. In terms of size, there has been no significant change.Associated edema and mass-effect persist with a midline shift to the right of up to 5 mm, distortion of the midbrain, and partial effacement of the quadrigeminal plate cistern on the left.Evolution of intraventricular blood product has also occurred with probable interval decrease in overall quantity. The ventricular system remains dilated and distorted, but dilatation is improved at least at the level of the temporal horns and fourth ventricle.New from the prior examination is a right holo-hemispheric subdural collection measuring up to 7 mm in thickness. This collection is T2 hyperintense, minimally FLAIR and T1 hyperintense relative to CSF, with a small area of more T1 hyperintense material layering dependently. The collection exerts mild generalized mass-effect upon the right cerebral hemisphere with evidence of sulcal effacement.Most of the areas of restricted diffusion seen on the prior examination have resolved. Small areas of restricted diffusion do, however, remain in the periatrial regions and along the right frontal horn and these cannot be entirely explained by the presence of blood products. No definite new areas of restricted diffusion are seen.The background brain continues to demonstrate extensive nearly confluent periventricular T2 hyperintensity which may reflect a combination of transependymal CSF flow and microvascular ischemic disease. Patchy T2 signal abnormality is also seen within the brain stem and cerebellum including one or two potentially new foci.Numerous foci of susceptibility are seen scattered through the cerebrum and cerebellum. Also noted is diffuse susceptibility weighted shading of the ependymal lining and the surface of the brainstem and cerebellum compatible with hemosiderosis. Sequelae of prior right frontal approach ventriculostomy catheter are seen.
1.Expected interval evolution of signal characteristics of a large left thalamic hematoma. No significant interval increase in size is demonstrated.2.Likewise, signal characteristics of the intraventricular blood products have evolved, and the overall quantity is probably decreased. There has been some interval decrease in the caliber of the ventricular system as well.3.New right holo-hemispheric subdural collection measuring up to 7 mm in thickness. This collection exerts mild generalized mass-effect on the right cerebral hemisphere. This collection may reflect blood product or a mixture of effusion and blood product. This finding was discussed with Dr. Kim at 9:20 a.m. on 1/30/15.4.Most areas of restricted diffusion seen on the prior examination have resolved or become smaller. Several areas persist but there are no definite new diffusion restricting lesions.