 MRI Brain:Images are somewhat limited by patient motion. There has been no significant interval change in appearance of the large peripherally T1 hyperintense right periventricular parenchymal hematoma, with associated surrounding residual vasogenic edema and localized mass effect. The leftward midline shift measuring 3 mm is unchanged. Trace T1 hyperintense intraventricular blood products are again seen along the left occipital horn. Posterior right cerebral sulcal effacement remains. There is no pathological enhancement.There are small scattered T2 hyperintense lacunar infarcts within the cerebellum bilaterally. A prominent chronic lacunar infarcts also seen along the right basal ganglia and the posterior aspect of the left basal ganglia. There are innumerable foci of susceptibility located throughout the cerebral hemispheres both centrally and peripherally. The extensive underlying periventricular and subcortical T2/FLAIR hyperintensities are consistent with chronic small vessel ischemic changes. The ventricular caliber is stable. The major cerebral flow voids are intact.MRA Brain: Severely motion limited exam. Within these limitations, there may be mild atherosclerotic irregularity within the M1 segments bilaterally. There is no significant intracranial stenosis. There is a mildly hypoplastic left A1 segment. The distal right V4 segment is developmentally diminutive. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild flattening of the carotid bulbs bilaterally. The common carotid arteries and cervical internal carotid arteries are otherwise normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion involving the cervical neck arteries. The right vertebral artery is smaller than the left.
1.Large evolving right intracerebral hemorrhage with localized mas effect, vasogenic edema and trace intraventricular hemorrhage, without significant change compared to the prior exam allowing for differences in technique.2.Extensive scattered punctate foci of susceptibility abnormality diffusely throughout the brain is most compatible with amyloid angiopathy and is may provide etiology for the underlying right sided hemorrhage.3.Extensive underlying chronic small vessel ischemic disease with multiple chronic lacunar infarcts.4.Limited MRA due to patient motion, although without definite flow-limiting stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.