Left-sided sensory disturbance. Evaluate for ICH or other etiology. Within the right lateral subinsular/posterior basal ganglia region is a small area of focal CSF intensity signal indicating encephalomalacia with minimal adjacent parenchymal T2/Flair hyperintensity consistent with marginal gliosis, which are consistent with the patient's previous parenchymal hemorrhage. There is ill-defined enhancement within the lateral subinsular cortex better seen on the delayed fat-saturated postcontrast imaging, with a small area of discontiguous linear enhancement just posteriorly which does not appear to be vascular in etiology. Small foci of restricted diffusion within the right subinsular region likely represent chronic blood products, with a background of significant susceptibility in the area of previous hemorrhage. Mild ex vacuo dilatation is noted about the posterior right lateral ventricle. Additional scattered punctate foci of susceptibility are also noted, including within the posterior fossa along the superior vermis and right cerebellum indicating additional probable chronic hemosiderin deposition. Moderate periventricular and subcortical white matter signal abnormality seen on T2/FLAIR is nonspecific but likely represents the sequela of chronic small vessel ischemic changes. There is no midline shift or herniation. The major cerebral flow voids are intact.
Interval expected evolution of area of previously seen hemorrhage in right posterior basal ganglia/subinsular region. Ill-defined and linear enhancement involving the right subinsular region in the location of the previous hemorrhage which may represent reactive sequela of the evolving area of chronic hematoma. Given the persistent enhancement at 4 months from the time of hemorrhage, follow up repeat CTA head could be obtained to exclude any underlying vascular malformation, or follow up MRI brain in 6-12 months is recommended to assess for resolution of imaging findings.