Clinical question: Cortical IPH. Signs and symptoms: Confusion. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate previously known small parenchymal hematoma in the left posterior temporal and unremarkable otherwise.Examination demonstrates an acute superficially located hematoma in the left posterior temporal lobe measuring at 12 times 17-mm in size and with minimal surrounding vasogenic edema and associated mass effect. There is no interval change since prior head CT exam.In addition the study demonstrates findings of moderate chronic nonhemorrhagic small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres, bilateral basal ganglia, left thalamus and minimally in the right pons.Post enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement and there is also no detectable enhancement of the left temporal hematoma or its surrounding parenchyma. The signal intensity of calvarium and soft tissues of the scalp remains in normal and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.
1.Negative diffusion weighted series.2.Left temporal small parenchymal hematoma measuring 12 x 17-mm and without abnormal enhancement. Nonhemorrhagic small vessel ischemic strokes of moderate degree.3.No detectable abnormal enhancement.4.Chronic