Intracranial hemorrhage. BRAIN MRI:Again seen is an intraparenchymal hematoma in the left frontal lobe centered at the left frontal operculum measuring approximately 5.0 x 3.4 x 3.7 cm. There is mild surrounding edema with local mass effect. Hematocrit effect is noted within the hematoma which may related to coagulopathy. Small foci of T1 hyperintensity are noted without definite enhancement. There is mild increase in surrounding vascularity which is likely reactive. No other foci of chronic hemorrhage. There is partial effacement of the left lateral ventricle. No significant midline shift. No uncal herniation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Dural venous sinuses are patent.Sella and orbits are grossly within normal limits. There is minimal fluid in the left mastoid air cells. Paranasal sinuses and mastoid cells are otherwise clear. There is lytic T1 hyperintense lesion involving the left frontal calvarium which likely represents a hemangioma. There is a 11 x 9 mm lytic lesion involving the right parietal calvarium with mild intracranial extension into the extra-axial space, best seen on coronal post gad series 1402 image 126/190 and foci of calcifications. Small scattered arachnoid granulations are seen. Bone marrow signal is benign.MRA HEAD:The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Anterior and bilateral posterior communicating arteries are present. No evidence of aneurysms or vascular malformations.
1. Lobulated intraparenchymal hematoma centered at the left frontal operculum as seen on recent CT. No associated abnormal enhancement or other enhancing intraprenchymal lesions to suggest malignancy. No other foci of hemorrhage. Given the size of the hematoma, however, small underlying lesion can not entirely be excluded and follow-up can be obtained as clinically indicated.2. No associated aneurysm or malformation.3. 11x9 mm enhancing, lytic right parietal calvarial lesion with intracranial extension into the extra-axial space and calcifications. Finding is favored to represent a benign etiology such as hemangioma or meningioma and can be further assessed on follow-up studies.