Female, 13 years old, with right frontal hemorrhage and intraventricular hemorrhage. Concern for vascular abnormality. A large acute right frontal lobe hematoma is evident occupying a large portion of the right superior and middle frontal regions with involvement of the right basal ganglia.Hemorrhage has dissected into the ventricular system with casting of the lateral, third and fourth ventricles. A left frontal approach ventricular shunt catheter is in place with its tip at the level of the left foramen of Monro.Relatively modest parenchymal edema is seen surrounding the frontal lobe hematoma. There is resultant generalized mass effect with midline shift to the left of at least 10 mm, effacement of the right frontal horn, and subfalcine herniation. The suprasellar and quadrigeminal cisterns remain patent.The right lateral ventricle is mildly dilated. The remainder of the ventricular system demonstrates relatively normal morphology.FLAIR hyperintensity within some of the sulci of the cerebral vertices may represent either a small amount of subarachnoid blood product or slow vascular flow.Diffusion restriction surrounding the right frontal hematoma may reflect a combination of ischemic injury and hemorrhage related artifact. A small focus of restricted diffusion is seen within the high left superior frontal gyrus. Mild restricted diffusion versus artifact is seen along the high interhemispheric falx posteriorly. Linear restricted diffusion is evident within the right putamen.A 15 mm long curvilinear and lobular region of enhancement is demonstrated just lateral and below the epicenter of the right frontal hematoma. On T1 precontrast images, there is the suggestion of a tuft or tangle of small vessels in this location.Dedicated MRA imaging fails to demonstrate any definite pathologic vasculature in this area, though this could be artifactual and due to compromised flow from edema and mass effect. The major intracranial vessels as visualized are patent and demonstrate no significant stenosis or occlusion. No other aneurysm or vascular abnormality is suspected.
1.Large right frontal lobe hematoma with dissection into the ventricles. Associated mass effect results in midline shift to the left, subfalcine herniation and effacement of the right frontal horn. The right lateral ventricle is mildly dilated.2.Just below and lateral to the center of the hemorrhage, a curvilinear enhancing structure is identified. On T1 precontrast images, there is a suggestion of a tuft or tangle of small vessels. MRA imaging fails to confirm this finding, though this could be a technical artifact. Findings are concerning for the presence of a vascular malformation. Further evaluation with conventional angiography is recommended.3.Several areas of ischemic injury are suspected including within the high left superior frontal gyrus, and within the right basal ganglia. Some of the parenchyma surrounding the right frontal lobe hematoma may also have sustained ischemic injury.