Intracranial hemorrhage. Brain MRI:The heterogeneously T1 isointense, T2-hypointense acute hematoma in the right frontal lobe with extension into the overlying sulci has not significant changed since the CT scan on the day prior. The associated adjacent parenchymal edema and mass-effect are also unchanged, including mild midline shift and compression of the frontal horn of the right lateral ventricle. The minimal hemorrhage within the posterior lateral ventricles is slightly increased or redistributed but there is no hydrocephalus. There are foci of susceptibility effect along the sulci bilaterally, reflecting the presence of blood products, which are new since previous CT scan. Postcontrast images are significantly limited by motion artifact. Grossly, there is no abnormal brain contrast-enhancement to suggest an underlying vascular lesion.There is a T2-hyperintense area along the right cortical spinal tract, which shows no diffusion restriction and has inferior extension into the posterior limb of the internal capsule and the right cerebral peduncle, compatible with chronic infarct with associated Wallerian degeneration. There is no acute infarct. Moderate cerebral white-matter T2-hyperintensity is nonspecific but likely represent chronic microvascular ischemia. There are chronic infarcts involving the cerebellar hemispheres, left more than right.There has been bilateral lens replacement. There is trace ethmoid sinus mucosal thickening. Fluid intensity fills both mastoid air cells which can be congestive. There is mild diffuse skull thickening but no destructive lesion.Cranial MRA:The study is at least moderately limited by patient motion. There is no large vessel occlusion or severe stenosis. There is no large aneurysm, however, there is incomplete coverage of the intracranial arteries. The left posterior cerebral artery is fetal in origin, which is a common normal variation.
1.The acute right frontal intraparenchymal hemorrhage has not significantly changed since the CT scan of the head on the day prior. Also, the associated mild surrounding edema and mass-effect are unchanged. The associated intraventricular and subarachnoid hemorrhages are increased but there is no hydrocephalus. Accounting for motion artifact, there is no abnormal brain contrast-enhancement to suggest an underlying vascular lesion.2.Cranial MR angiogram is at least moderately limited by patient motion and incomplete head coverage. There is no large vessel occlusion, severe stenosis or large aneurysm.3.Otherwise, there are chronic infarcts and moderate cerebral white-matter chronic microvascular ischemia.