Intracranial hemorrhage. Please evaluate for underlying cause. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an intraparenchymal hematoma (IPH) centered in the right superior temporal lobe sulcus and right superior temporal gyrus but involves the posterior aspect of the right middle temporal gyrus and a small portion of the posterior aspect of the right inferior temporal gyrus and extends into the right inferior parietal lobule. It measures 89x51mm sagittal dimensions, 51x44mm coronal dimensions and 83 x 48 mm axial dimensions. The discrepancy in size between these measurements and the CT are likely related to differences in modality because there are fluid like components with fluid fluid levels along the anterior aspect of the hematoma which are hypodense on the CT scan. There is a halo of edema present.The septum pellucidum is shifted 7mm to the left of midline and is stable since the prior CT. There is compression of the right lateral ventricle.There is redemonstration of a subdural hematoma and subarachnoid blood adjacent to the above described IPH. The subdural hematoma measures 5mm thickness. There is a small amount of intraventricular blood present.The right PCOMA appears compressed. The right nasal vein of Rosenthal is asymmetrically smaller.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is no convincing evidence for microhemorrhage to support a diagnosis of amyloid angiopathy.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Incidental note is made of partial empty sella.
1.Large intraparenchymal hematoma centered in the right temporal lobe and its sulci with associated subdural hematoma and subarachnoid blood as well as uncal herniation.2.No convincing MRI evidence for AVM on the basis of this exam although a small AVM may not be visible or an AVM may be obscured by mass effect.3.No convincing MR evidence for amyloid angiopathy.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 