 MRI BRAIN:There is redemonstration of the intraparenchymal hematoma involving the right thalamus and the medial aspect of the basal ganglia. The hematoma measures approximately 24 x 14 x 14 mm (AP x T x CC), slightly increased in size since the previous study. There is a small focus of restricted diffusion in the anterosuperior aspect of the hematoma. The hematoma is abutting and mildly compressing the lateral aspect of the posterior right lateral ventricle. There is mild edema surrounding the hematoma.Multiple foci of susceptibility signal are dispersed throughout the brain parenchyma, representing old blood products from a previous microhemorrhages. These may be related to chronic hypertension versus amyloid angiopathy.There are T2/FLAIR nonspecific foci and confluence of hyperintensities in the periventricular and the subcortical white matter and in the centrum semiovale. These are more likely vascular related.MRA BRAIN:The internal carotid arteries are normal bilaterally. The anterior, middle, and posterior cerebral arteries are patent with no evidence of significant stenosis or aneurysm. The anterior communicating artery is patent. The posterior communicating arteries are not well visualized and most likely diminutive.The basilar is patent. Vertebral arteries are patent with dominant right vertebral artery.
1. Evolving intraparenchymal hemorrhage of the right thalamus and the right basal ganglia with a small focus of restricted diffusion in the anterosuperior aspect of the margins of the hematoma which may represent small focus of ischemia. The edema surrounding the hematoma is more prominent in the current study than in the previous head CT.2. Confluence of T2/FLAIR hyperintensities in the corona radiata and in the central semiovale, representing chronic small vessel ischemic changes. 3. There are multiple foci of susceptibility signal dispersed throughout the brain parenchyma, representing old microhemorrhages. These microhemorrhages are more likely due to hypertensive disease. Amyloid angiopathy cannot be excluded.4. The MRA demonstrates normal anterior and posterior brain circulation. There is no significant stenosis or aneurysm.