Female, 46 years old, with intracranial hemorrhage. A hematoma is redemonstrated centered on the cerebellar vermis with signal characteristics (T1 isointense and T2 hypointense) compatible with an acute time course. Accounting for differences in technique, the size of the hematoma has not significantly changed from the prior CT examination. The parenchyma surrounding the hematoma demonstrates mild edema and there is mass effect partially effacing the fourth ventricle. A small focus of possible restricted diffusion with matching T2 FLAIR signal abnormality is seen within the left aspect of the anterior corpus callosum. Elsewhere, fairly extensive patchy and focal periventricular T2 hyperintensity is seen. There are a few scattered lesions in the brain stem and cerebellum as well. No other significant parenchymal edema is detected. A small amount of blood product is evident layering within the occipital horns. However, the ventricular system is not dilated.Allowing for motion artifact on the MRA images, no vascular lesion is seen within the vicinity of the vermian hematoma. No significant vascular stenosis or occlusion is demonstrated elsewhere. No aneurysms are suspected. The cervical vessels are likewise free of significant vascular stenosis or occlusion.
1.An acute hematoma is redemonstrated centered on the cerebellar vermis. Mild associated mass effect is seen along with mild intraventricular blood product.2.No obvious vascular or nonvascular lesion is seen adjacent to the hematoma. A lesion within the hematoma may not become visible until the blood product has at least partially resolved.3.Fairly extensive scattered periventricular T2 hyperintense lesions are seen, along with a possible diffusion restricting lesion within the left anterior corpus callosum. These findings could reflect microvascular ischemic disease particularly if there are known risk factors. In this age group, however, demyelinating disease should also be considered as well as a vasculitic process.4.No significant vascular stenosis is identified in the head or neck.