Clinical question: Please compare to prior exam. Signs and symptoms: Patient with left thalamic IPH.. The status-post EVD placement. Nonenhanced brain MRI:Examination demonstrates restricted diffusion involving the cortex of left posterior frontal left parietal region and extending into the left basal ganglia. There is significant distortion of the images at the level of previously noted large hemorrhage in the left basal ganglia and thalamus.Restricted diffusion is also noted involving the cortex left mid to posterior temporal lobe. All regions of the above detailed restricted diffusion demonstrate increased flair signal intensity in with resultant thickening of the cortex and effacement of the adjacent cortical sulci.A large irregularly shaped a second hematoma measures at least at 15 9 x 51 mm in transaxial dimensions. The hematoma and surrounding vasogenic edema results in significant mass effect on the third ventricle which is deviated across the midline to the right of approximately 15 mm. The left lateral ventricle remains compressed and there is mild prominence right lateral ventricle. When compared with prior CT exam there may be slight interval increased size of right lateral ventricle. A right frontal approach ventricular catheter with the tip in the anterior body of right lateral ventricle is noted. On prior head CT study the tip of the catheter was in the third ventricle.Flair and T2 weighted images also demonstrate findings suggestive of mild to moderate chronic small vessel ischemic strokes. Tiny foci of flair hyperintensity in the pons are also believed to represent chronic small lacunar infarct. Susceptibility MRI sequence demonstrate several punctate size foci of susceptibility throughout bilateral cerebral hemispheres and pons.The signal void of major intracranial branches are identified.
1.Regions of restricted diffusion involving the cortex of mid to posterior left temporal lobe and extending superiorly into the left posterior frontal -- parietal region.2.Large acute hematoma in the left thalamus/basal ganglial without convincing evidence of interval increased size since prior head CT exam.3.Hematoma and surrounding edema results in mass effect and 15-mm with deviation of third ventricle across the midline to the right.4.Right frontal approach ventricular catheter with the tip now in the anterior body of right lateral ventricle as compared to prior head CT which showed the tip in the third ventricle. 5.There is suggestion of mild interval increased size of right lateral ventricle.6.Mild findings of chronic small vessel ischemic strokes. Multiple punctate foci of susceptibility in bilateral cerebellar hemispheres and pons.