65 years, Male, with nontraumatic subarachnoid hemorrhage. Additional patient history includes multiple myeloma, status post treatment four years prior, thrombocytopenia, and current bacterial endocarditis. MRI BRAIN
1. Multiple acute to subacute supra and infratentorial infarcts in multiple vascular territories, some of which are associated with scattered areas of intracranial hemorrhage and suboptimally evaluated nodular enhancement. For example restricted diffusion in the left parieto-occipital region with adjacent hemorrhage may represent hemorrhagic conversion of an embolic infarct (perhaps related to infective endocarditis). Subarachnoid hemorrhage is most evident in the left frontal and opercular regions, possibly related to thrombocytopenia. No intracranial abscess or empyema. 2. Note MRA centered at the circle of Willis does not include the entire head. No intracerebral aneurysm however is identified in the field-of-view within limits of mild motion degradation. If clinically appropriate CTA may be considered to evaluate the more peripheral vasculature (for possible pseudoaneurysms).