Clinical question: Evaluate underlying structural lesion like tumor underneath hemorrhage. Signs and symptoms: Hemorrhage Pre-and post-enhanced brain MRI:Examination demonstrates a focus of acute parenchymal hemorrhage in the left postcentral gyrus measuring approximately at 8 x 13-mm in size. There is minimal surrounding cortical restricted diffusion. Findings is believed to represent a small focus of hemorrhagic stroke. Post-enhanced images demonstrate expected minimal rim enhancement of hematoma and negative otherwise.Examination in addition demonstrate mild to moderate degree of chronic small vessel ischemic strokes primarily in the periventricular and to a lesser degree in subcortical white matter of cerebral hemispheres. Minimal similar finding in the right basal ganglia and few similar foci in the pons are also noted. Findings are highly suggestive of chronic small vessel ischemic strokes. There is normal thickness of susceptibility signal changes with the above described chronic small vessel ischemic strokes however there are multiple foci of susceptibility in bilateral cerebral hemispheres and left thalamus suggestive of prior microhemorrhages and suspected of amyloid angiopathy.The cortical sulci and ventricular system is within normal size and morphology for patient's stated age. The signal voids of major intracranial arterial branches are identified.The signal void of intracranial venous sinuses are within normal and the normal pattern of enhancement.
1.Examination demonstrate a small hemorrhagic stroke in of the left postcentral gyrus and without evidence of underlying tumor or vascular pathology.2.Mild chronic small vessel ischemic strokes primarily in the subcortical/periventricular white matter and minimally in the right basal ganglia and multiple chronic strokes in the pons. There are multiple small varying size foci of susceptibility throughout bilateral cerebral hemispheres consistent with chronic micro-hemorrhages which considering patient's stated age of 88 likely representing amyloid angiopathy.