76-year-old woman with headache and hypertension. Unresponsive evaluate for ICH. There is a parenchymal hemorrhage in the left parieto-occipital region. The hemorrhage measures 4.8 x 4.3 cm in the axial plane and extends to the cortical surface. No underlying lesion (such as an AVM) is visible on this study. A subdural hematoma measuring approximately 7 mm in thickness is present. The hemorrhage has a surrounding rim of edema and causes mass effect with near total effacement of the left lateral ventricle and approximately 12mm of midline shift at the level of the thalamus. There is partial effacement of the left aspect of the suprasellar cistern, suggesting left uncal herniation. The quadrigeminal cistern is partially effaced. In addition, the brainstem is shifted to the right, causing effacement of the right prepontine cistern. The cortical sulci of both cerebral hemispheres are effaced. Low attenuation with loss of gray-white differentiation is present in the white matter of the right cerebral hemisphere and is most pronounced in the right frontal lobe. This may represent ischemia or edema and could be better evaluated with MRI. Gray-white differentiation is otherwise preserved. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Water density fills the posterior nasopharynx -- possibly representing vomitus or secretions.
1. Left parieto-occipital parenchymal hemorrhage causing mass effect and about 12 mm of midline shift. No underlying lesion such as an AVM is visible on this study. Further evaluation for an underlying lesion is recommended as clinically appropriate.2. Findings of elevated intracranial pressure including effacement of cortical sulci, left uncal herniation, and partial effacement of the quadrigeminal cistern.3. Low attenuation in the white matter of the right cerebral hemisphere with loss of gray-white differentiation concerning for ischemia. This finding could be better evaluated with MRI.This report was discussed by telephone with the Dr. Eric and Dr. Shakur at 4:10 PM.