Clinical question: Stable versus worsening hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced brain MRI:No evidence of restricted diffusion on diffusion-weighted series.Metallic artifact representing an aneurysm clip in the right sylvian fissure obscures the detail at this level. Mild parenchymal T2 hyperintensity suggestive of region of encephalomalacia in the right inferior frontal remain similar to prior exam.A small focus of FLAIR hyperintensity edema and containing a small amount of hemorrhage in the cortex and subcortical white matter of right frontal lobe under a craniotomy flap is again identified and with suggestion of subtle interval decreased edema/improvement.There is also interval significant decrease to near complete resolution of the scattered foci of subarachnoid hemorrhage since prior exam.Ventricular system remain within normal size and without deviation of midline.Cortical sulci and the CSF cisterns remain widely patent and unremarkable similar to prior exam.Patchy opacification of bilateral mastoid air cells similar to prior study.Interval resolution of sphenoid sinus disease since prior exam.
1.No acute intracranial process and negative diffusion weighted series.2.Interval improvement of postoperative changes of right sided craniotomy.3.Significant interval decrease to near complete resolution of the scattered subarachnoid hemorrhage since prior exam.4.Interval decreased focus of T2 hyperintensity/edema in the right frontal cortex and subcortical white matter with hemorrhagic changes.5.Stable ventricular system and with maintained midline.