Male, 81 years old, with left frontal hemorrhage and vasogenic edema, suspect underlying mass. Found down, Glasgow Coma Scale 3-8, C-spine clearance needed. Brain MRI:Restricted diffusion is seen within the left cingulate gyrus and to a mild degree in the right cingulate gyrus. Apart from artifactual diffusion restriction caused by intracranial hemorrhage, there are a few additional scattered small foci of diffusion restriction seen in the left parietal and temporal cortex and perhaps minimally in the right posterior frontal lobe.A large left frontal lobe parenchymal hematoma is again seen showing no significant change in size or morphology relative to prior CTs. Intraventricular extension is also demonstrated with a significant quantity of blood in the left lateral ventricle, with smaller quantities of blood in the right lateral ventricle, third and fourth ventricles. Again, the quantity and distribution of intraventricular blood product does not appear to have changed.Significant generalized mass effect persists with a midline shift to the right of 11 mm and subfalcine herniation including the ACA vessels. The suprasellar and quadrigeminal plate cisterns remain patent.On postcontrast images, no definite enhancement is seen within or around the left frontal lobe hematoma cavity apart from intrinsic T1 signal induced by the blood itself. No obvious mass lesion is detected though a small lesion could be obscured by the large hematoma. Subtle sulcal and gyriform enhancement is seen along the left cingulate gyrus corresponding to the restricted diffusion. A small focus of enhancement within the posterior right operculum is also seen correlating to restricted diffusion in this area. The superior ophthalmic veins are prominent bilaterally likely reflecting increased intracranial pressure. They were less prominent and showed no evidence of early filling on the prior CTA.A right frontal approach ventricular shunt catheter is seen in stable position. Minimal parenchymal blood product is again seen along the catheter tract. The ventricles remain dilated but similar to that seen on prior CTs.Brain MRA:Mild distal ACA narrowing was better assessed on prior CTA. No other significant intracranial vascular stenosis is seen. No aneurysm or vascular malformation is detected.Cervical spine MRI:Reversal of the cervical lordosis is noted. There is in addition a grade 1 retrolisthesis of C5 relative to C6. Vertebral body height is within normal limits. No concerning marrow replacement is seen. Minimal elevated STIR signal is seen within the C3-C6 vertebral bodies, likely degenerative. Likewise, increased T2 signal within the C3-4 through C5-6 intervertebral discs likely reflects degeneration.The paraspinal soft tissues are unremarkable. No evidence of soft tissue or ligamentous injury is seen. The spinal canal is congenitally slender. The spinal cord is chronically thinned with scattered foci of T2 hyperintensity beginning at C3 and continuing down to C6. No epidural collections are suspected.C2-3: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild right and moderate left foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. No significant generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing.C6-7: Minimal disc degeneration without significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.
1.Demonstration of a large left frontal lobe hematoma without significant interval change. No obvious etiology for the hemorrhage is seen, and in particular, no large mass lesion is demonstrated. Please note that small lesions may be obscured by the large quantity of hemorrhage.2.Extensive intraventricular blood product also shows no significant interval change in quantity or distribution. The ventricular system remains dilated but similar to prior.3.Extensive generalized mass effect is seen with substantial rightward midline shift and subfalcine herniation. No significant change is noted.4.Acute ischemia is seen within the ACA distributions, mostly affecting the left cingulate gyrus and to a much lesser degree the right cingulate gyrus. A few additional scattered foci of restricted diffusion are seen in both cerebral hemispheres. This ischemia may be related to subfalcine herniation and compromise of the ACA vessels.5.On dedicated MRA images, no specific vascular lesions are seen which would account for the intracranial hemorrhage.6.No evidence of any acute cervical spine osseous or soft tissue lesion is seen.7.The spinal cord demonstrates evidence of chronic myelomalacia from C3 through C6, where degenerative disc disease is at its worst.