Findings
- Large acute parenchymal hematoma centered in the left temporal resection bed measuring 8.5 x 6 x 5.5 cm (volume = 140 mL) with surrounding vasogenic edema
- Associated mass effect with left hemispheric sulcal effacement, left to right midline shift measuring 13 mm at the Foramen of Monro with left to right subfalcine herniation, near complete effacement of the left lateral ventricle, and left uncal herniation with partial effacement of the suprasellar cistern and mass effect upon the midbrain
- Small amount of hemorrhage extending into the left lateral ventricle
- Mild dilation of the posterior body and atrium of the right lateral ventricle
- Bilateral mixed attenuation cerebral convexity extraaxial collections measuring up to 8 mm in thickness on the left
- Age-indeterminate lacunar infarct in the inferomedial right cerebellum
- Extensive, confluent hypoattenuation throughout the subcortical and periventricular cerebral white matter
- Intracranial atherosclerosis
- Sequelae of recent left pterional craniotomy with overlying scalp hematoma
- Right greater than left mastoid effusions
- Glaucoma reservoir along the lateral aspect of the left globe
Diagnosis
Acute intracranial hemorrhage with subfalcine and uncal herniation
Sample Report
Large acute parenchymal hematoma centered in the left temporal resection bed measuring 8.5 x 6 x 5.5 cm (volume = 140 mL) with surrounding vasogenic edema.
Associated mass effect with left hemispheric sulcal effacement, left to right midline shift measuring 13 mm at the Foramen of Monro with left subfalcine herniation, near complete effacement of the left lateral ventricle, and left uncal herniation with partial effacement of the suprasellar cistern and mass effect upon the midbrain. No cerebellar tonsillar herniation.
Small amount of intraventricular hemorrhage in the left lateral ventricle. Mild dilation of the posterior body and atrium of the right lateral ventricle raises concern for developing noncommunicating hydrocephalus.
Sequelae of recent left pterional craniotomy with bilateral mixed attenuation cerebral convexity extraaxial hematomas versus hematohygromas measuring up to 8 mm in thickness on the left.
Age-indeterminate lacunar infarct in the inferomedial right cerebellum, which could be further evaluated by brain MRI if clinically indicated.
Extensive, confluent hypoattenuation throughout the subcortical and periventricular cerebral white matter which may relate to edema and/or sequelae of chronic small vessel disease.
Discussion