56 years Male (DOB:12/19/1959)Reason: evaluate for underlying lesion associated w/ bleed History: as abovePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic focus present in the vermis also identified on recent CT of the head. It is associated with susceptibility effect and some bright signal on T1-weighted imaging. There is no significant contrast enhancement associated with this. No other lesions are identified within the brain parenchyma.Punctate focus of susceptibility in the left cerebellar hemisphere most likely represents a microhemorrhage. In isolation this is a unknown clinical significance.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is some leptomeningeal FLAIR signal hyperintensity present along the occipital lobes and medial parietal lobes as well as the high convexities.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a hemorrhage present in the vermis. Etiology is not clear on the basis of this exam. An underlying vascular lesion such as a cavernoma cannot be excluded. There is no MR evidence to suggest underlying neoplasm or arteriovenous malformation on the basis of information available. A micro-AVM or a dural arteriovenous fistula would not be readily identified on exam like this.2.Findings suggest leptomeningeal reaction adjacent to the occipital and parietal lobes. Differential considerations include subarachnoid blood, hyper oxygenation during the exam (which was done under general anesthesia) as well as a mild form of posterior reversible encephalopathy syndrome. Please correlate with the anesthesia records during the exam.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.