Subarachnoid hemorrhage [430], Reason for Study: ^Reason: ICP/SAH History: HA/syncope, history of recent anticoagulation and head trauma. There is right temporal ICH measured about 13.6mm x 43.6mm x 24mm with surrounding edema.Main portion of the ICH shows high signal intensity on T1 weighted image indicating subacute hemorrhage.Central portion of the ICH shows low signal intensity areas which could represent deoxyhemoglobin or could include vascular signal voids.There are also bihemispheric parietal and occipital subarachnoid signal voids on gradient echo images and high signal intensities on FLAIR images indicating subarachnoid blood products. In addition, there is focal susceptibility artifacts on the right lateral ventricle occipital horn indicating possible intraventricular hemorrhage.Considering the patient's history of recent anticoagulation and head trauma, above described findings can be understood. However, etiology of unusual location ICH should include arteriovenous malformation and dural arteriovenous shunting. Therefore, diagnostic angiography can be considered for further imaging valuation.The ventricles, sulci and cisterns are symmetric. There is no restricted diffusion indicating acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No intracranial arterial luminal stenosis. No intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate intra dural sinus filling defects on the right transverse sinus and sigmoid sinus indicating intra dural thrombosis. Superior sagittal sinus and left transverse sinus and left sigmoid sinus appear to be patent. However, forward flow through the right transverse sinus and sigmoid sinus appear to be maintained. Deep venous system including straight sinus as well as bilateral internal cerebral veins were patent. Vein of Galen was not clearly visualized on this scan, however, since there is no evidence of venous congestive encephalopathy of deep structures, it could well be an artifactual.
1. Right temporal ICH, bilateral parietal and occipital SAH and right lateral ventricle occipital horn focal IVH as described above.2. Right transverse sinus and sigmoid sinus intraluminal filling defects but maintaining forward flow.3. No intracranial arterial aneurysm, no evidence of intracranial arterial luminal stenosis.4. Possibility of brain AVM or DAVF cannot be excluded with MRI and MRA. If indicated, diagnostic catheter angiography can be considered. 