 There are findings related to an acute large parenchymal hematoma within the left occipital lobe with surrounding vasogenic edema that results in unchanged mass effect on the local sulci, the left atrium and left occipital horn, as well as a 3-mm rightward midline shift. The size of the hematoma is unchanged, measuring 4.5 x 2.9 cm. There is no intraventricular hemorrhage and the ventricles are unchanged in size. There is a 1.6 x 1.7 cm ill-defined round area of T2/FLAIR hyperintensity along the left cerebellar folia corresponding to an area of low density on CT, with mild mass effect along the gray white matter junction. This has a slightly striated appearance on coronal T2 weighted images (71/9), without significant disruption of the underlying cerebellar architecture which can still be discerned. There are additional nonspecific foci of subcortical FLAIR hyperintensity in the bilateral paramedian parietal regions at the convexity.There is FLAIR signal hyperintensity throughout multiple frontal and parietal sulci bilaterally, right greater than left with minimal associated susceptibility effect, corresponding to areas of sulcal hyperdensity on CT. There are scattered areas of sulcal FLAIR hyperintensity elsewhere without susceptibility which may relate to artifactual signal from sedation/oxygenation.There is no evidence of acute infarct. The major cerebral flow voids are intact. There is a moderate-sized air-fluid right maxillary sinus. There is non-mucosal thickening within the sphenoid sinuses.
1.Left occipital acute parenchymal hematoma is unchanged in size with unchanged mass effect and minimal midline shift.2.Rounded area of abnormal signal in the left cerebellum with mild mass effect. The differential diagnosis includes infectious/inflammatory etiologies such as a focal cerebellitis, demyelinating, and ischemic etiologies. Follow-up imaging with contrast is recommended, also to exclude possibility of neoplasm.3.Mild subarachnoid hemorrhage over the bilateral frontal and parietal lobes.4.Nonspecific subcortical FLAIR hyperintensity in the bilateral paramedian parietal lobes may represent additional subarachnoid hemorrhage or sedation artifact.5. Moderate sized air-fluid level within the right maxillary sinus. Please correlate clinically for acute sinusitis.