Assessment #1 case-set #2 case #8

An acute intraparenchymal hemorrhage in the left posterior frontal lobe.
Adjacent vasogenic edema and ischemic changes.

Acute parenchymal hemorrhage centered in the left basal ganglia measuring… volume… There is local mass effect without midline shift. In the absence of trauma, this finding may be hypertensive in etiology. Differential considerations include hem transformation of infarct, tumor, AVM.

Bifrontal extraaxial collections measuring x mm, likely representing subacute or chronic subdural hematomas.

L cerebellar hypodensity-remote infarct.
R cerebellar hypodensity-age indeterminate infarct.
BL temporal lobe-age indeterminate infarcts.

macro old brain.

BL pseudophakia.

intraparenchymal hemorrhage l basal ganglia measuring x with surrounding edema and x midline shift, likely 2/2 htn

loss of grey white right insular cortex also concerning for ischemia in mca territory

no hydro

recommend mri for further eval

Acute hemorrage within the L putamen. No madd effect. No herniation

Focal area of hyperdensity in the left basal ganglia, likely representing hemorrhage. Mild dilation of the lateral and third ventricles. No abnormal extra-axial fluid collection or mass effect.

intracranial hemorrhage in left basal ganglia, likely related to hypertension

lt bg ip hem

Acute intraparynchymal hemorrhage centered in the left basal ganglia with surrounding edema. No associated mass effect.

Left basal ganglia hemorrhage with surrounding edema and slight midline shift. No intraventricular involvement.
No extra-axial hemorrhage, fracture or soft tissue abnormality.

There is high attenuation in the thalamus, concerning for acute intraparenchymal bleed.

No midline shift. Gray-white differentiation maintained. Basilar cisterns are maintained.

left basal ganglia IPH

Intraparenchymal hemorrhage in left putamen, consistent with hypertensive bleed. Mild global cerebral volume loss.

Acute left lentiform nucleus intraparenchymal hemorrhage measuring __x___x___x mm with mild surrounding vasogenic edema. No significant mass effect, midline shift or herniation. Findings are suggestive of hypertensive basal ganglia hemorrhage.

FINDINGS:

Acute hemorrhage within the left basal ganglia. Surrounding vasogenic edema without mass effect. Age-approriate cerebral atrophy. The mastoid air cells and paranasal sinuses are clear.

IMPRESSION:

Acute left basal ganglia hemorrhage.

Acute intraparenchymal hemorrhage of the left internal capsule and basal ganglia, with some extension superiorly to the adjacent ventricle without obvious intraventricular hemorrhage.

Diffuse dilatation of the lateral ventricles and rounding of the third ventricle concerning for early hydrocephalus.

acute intraparenchymal hematoma involving the left lentiform nucleus/external capsule with mild surrounding vasogenic edema.

There is intracranial hemorrhage in the left basal ganglia region with surrounding edema. No visible infarct. No mass effect or hydrocephalus. Mastoid air cells and paranasal sinuses are clear. Calvarium is intact.

L thalamus IPH

Left basal ganglia acute hemorrhage.

Acute left basal ganglia hemorrhage with circumferential vasogenic edema, suggestive of hypertensive hemorrhagic infarction. Chronic periventricular white matter ischemic changes and encephalomalcia in right MCA distribution.

Left intraparencymal hemorrhage in the insula.
Right cortical volume loss adjacent to the posterior horn of the right lateral ventricle.

acute ip hemm, left bg.

left basal ganglia intraparenchymal hemorrhage
small amount of SAH in the left sylvian fissure.

L BG/int capsule IPH, measuring x by y by z (v total vol) , c/f IPH, likely HTN in etiology given location.

Several lacunar infarcts in the b/l cerebellum

diffuse cereb/cerebell vol loss, ex vacuo

Acute intraparenchymal hemorrhage in the left putamen/lentiform nnuclus which measures xxx. There is extension of hemorrhage in a linear fashion toward the left lateral ventricle but without evidence of intraventricular hemorrhage/ Local mass effect with sulcal effacement. Mild midline shift measuring***. Age advanced macro CT old brain.

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Acute intraparenchymal hemorrhage centered over the left basal ganglia, measuring approximately X (ml), likely hypertensive hemorrhage. Left to right midline shift measuring approximately X. Bilateral pseudophakia.

Acute Hemorrhage in the left basal ganglia. No Herniation. Encephalomalacia in the right temporal lobe.

intraparenchymal bleed in the left basal ganglia

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Acute IPH and surrounding edema in the left posterior limb of internal capsule. There is associated small hyperdense vessel extending to the left lateral ventricle, suggesting underlying vascular malformation.

Acute parenchymal hemorrhage involving the left basal ganglia most consistent with hypertensive hemorrhage.

lacunar

Acute intraparenchymal hemorrhage centered within the left basal ganglia, volume measured at x cm with minimal surrounding vasogenic edema. No appreciable mass effect. No hydrocephalus.

Acute intraparenchymal hemorrhage in the L lentiform nucleus measuring (x ml) concerning for hypertensive hemorrhage.

No sig mass effect or hydrocephalus.

Acute 2 x 3 cm hemmorage in the left basal ganglia.

Intraparenchymal hemorrhage within the left basal ganglia (measurement). Surrounding vasogenic edema. Notably there is hypodensity of the subinsular ribbon, which may reflect ischemia or vasogenic edema. Mild midline shift with enlarged ventricles, may reflect ex vacuo dilatation but acute hydrocephalus cannot be ruled out in the absence of prior imaging. Location favors hypertensive hemorrhage. Recommend follow up MRI for further evaluation.

Trace subarachnoid hemorrhage layering over the anterior cerebellum.

Age-indeterminate infarcts in the bilateral cerebellum. Right parietal encephalomalacia.

-Left basal ganglia hemorrhage most likely hypertensive in etiology consdering location if supported clinically. Linear hyperdensity extends superiorly from the hemorrhage but does not dissect into the left ventricle.
-Surrounding vasogenic edema
-Mild Left to right midline shift
-White matter disease and ex vacuo dilation of ventricles

Intraparenchymal hemorrhage centered in the left internal capsule/basal ganglia with associated vasogenic edema, sulcal effacement, and approximately ___ of midline shift. The temporal horn of the Left lateral ventricle appears slightly larger on the provided views, and this could indicate developing ventricular entrapment. Recommend attention on follow-up imaging.
Multiple age indeterminate infarct within the cerebellum. Recommend correlation with prior imaging or MRI for further evaluation. Several scattered hypoattenuating regions within the frontal lobes and right basal ganglia could also represent age indeterminate infarct.

Multiple hypoattenuating foci consistent with old infarcts. Hyperdense blood adjacent to the left basal ganglia, with adjacent mass effect.

iph, r mca

Acute L basal ganglia hemorrhage

xx

Basal gang acute left hem
Trace right shift

acute parynchemal hemorahage centered in l basal ganglia measuring _x_x_x (estimated volume x). mild suroundng mass effect w/ sulcal effacement. no midline shift. no hydro. likely etiology of this hemorhage is hypertensive gievn its location.
no acute large vascualr terrritro infarct.
no acute hydrocephalus.
remote appearing infarcts in b/l cerebellar hemispheres.

Mass effect with intraparenchymal hemorrhage adjacent to the left internal capsule

Acute intraparenchymal hemorrhage centered at the L basal ganglia measuring x by x by x cm. Local mass effect with sulcal effacement and mild L to R midline shift. This may relate to hypertensive hemorrhage given its location. Other differential considerations include hemorrhagic mass and infarct. MRI is recommended for further evaluation. No evidence of intraventricular hemorrhage or ventricular entrapment. Multiple areas of hypodensity within the bilateral cerebeller hemispheres which likely relate to remote infarcts.

L basal ganglia IPH. suggestive of hypertensive hemorrhage
Old infarct in R mca territory

Hyperattenuating focus with the left basal ganglia measuring approx x by x representing intraparanchymal hemmorhage favored to be of hypertensive etiology given location. Mild leftward midline shift.

Acute left basal ganglia hemorrhage.

Acute, left basal ganglia intraparenchymal hemorrhage with local mass effect. No significant midline shift or evidence for hydrocephalus. No intraventricular extension or signs of extraaxial hemorrhage. This pattern favors a hypertensive hemorrhage. Mildly dilated ventricles out of proportion to brain volume loss, which may relate to NPH in the right setting. Intracranial calcifications. Remote infarcts of the cerebellum

Acute intraparenchymal hemorrhage with an estimated volume of xx centered in the left basal ganglia. Likely hypertensive in etiology. Mild adjacent sulcal effacement. Pan ventricle enlargement which may relate to volume loss however a component of hydrocephalous cannot be excluded in the absence of priors. No midline shift or hernation.

Acute left IPH centered in the left basal ganglia concerning for hypertensive hemorrhage. Mild associated vasogenic edema. No midline shift or herniation. Diffuse chronic white matter disease and cerebral atrophy with ex vacuo dilation of the ventricles. Multiple scattered prior bilateral cerebellar infarcts.

Old lacunes in bilateral cerebellum and right basal ganglia.

Acute intraparen hem within left basal ganglia measuring blah and volume. Surrounding edema and hemorrhage resulting in effacement of the left lateral ventricle and left Sylvia fissure, with and minimal left to right midline shift.

Findings most consistent with hypertensive hemorrhage.

Acute left basal ganglia intraparenchymal hemorrhage. No midline shift, herniation, or hydrocephalus.

Acute intraparenchymal hematoma in the L putamen with adjacent edema, local L ventricular and sulcal effacement, and slight midline shift. Ddx for basal ganglia hematoma favors hypertensive hemorrhage if history of HTN.

The lateral and third ventricles appear prominent given absence of prior imaging for comparison, with a relatively normal fourth ventricle. This may be secondary to developing obstructive hydrocephalus or age related ex vacuo dilation.

Scattered hypoattenuation within the R posterior temporal lobe white matter. This may reflect age indeterminate ischemia or chronic white matter disease. MRI could further evaluate.

acute intraparenchymal hematoma measuring centered with the left lenticular nucleus with surrounding vasogenic edema. resultant mild local mass effect and rightward midline shift. Location is suggestive of hypertensive etiology.

Intraparychemal hemorrhage centered in the left basal ganglia, concerning for hypertensive hemorrhage. There is local mass effect and vasogenic edema.

Acute left basal gangli hemorrahge with small amount of surrounding edema and mild local mass effect without herniation.

Likely remote infarct in the left cerebellar hemisphere.

Macro old brain.

Intraparenchymal, centered on left putamen. vasogeneic edema. midline shift.
Age indeterminate bilateral cerebellar lacunar.

Acute intraparenchymal hemorrhage centered within the left basal ganglia in the region of the putamen measuring X (volume ~ x). Surrounding vasogenic edema and x mm of rightward midline shift. Location is suspicious for hypertensive etiology. Consider CTA and MRI for further evaluation.
No intraventricular extension or hydrocephalus.
Remote appearing infarcts within the bilateral cerebellar hemispheres.
Mild macro CT old brain.

acute intraparenchymal hemorrhage of the left basal ganglia measuring X x X x X mm (Xcc) with surrounding edema and mild local mass effect. no ventricular extension. no hydrocephalus. no midline shift.
Primary differential consierations include hypertensive hemorrage but hemorrage into an infarct is a possibility. Consider MRI for further evaluation if it will affect clinical management.

Intraparenchymal hemorrhage in the left external capsule/globus pallidus measuring x mL. Surrounding edema. Mild left to right midline shift.

Multiple age indeterminate infarcts of the bilateral MCA territory and bilateral cerebellar hemisphere.

Acute intraparenchymal hemorrhage within the left putamen with surrounding edema ad trace adjacent sulcal crowding and left to right midline shift without frank herniation. No hydrocephalus.

Punctate calcifications along bilateral cerebellopontine angles, the left ACA/MCA junction, and along the left ophthalmic artery with hyperattenuating MCA’s bilaterally and subtle bilateral gray-white differentiation loss along the right MCA and left ACA/MCA territories concerning for embolic ischemia. Recommend MRI without contrast for further evaluation.

Heavy burden of intracranial atherosclerosis.

Technically age-indeterminate but remote appearing infarcts within the right frontal and temporal lobes.

Global parenchymal volume loss with ex-vacuo ventricular enlargement.

basal gang hem

Acute left basal ganglia IPH with estimated volume of *** with surrounding vasogenic edema which result in mild local mass effect on the left lateral ventricle without significant midline shift or evidence of obstructive hydrocephalus. This is favored hypertensive in etiology given location, however could also represent hemorrhagic conversion of an infarct or hemorrhagic mass. Recommend MRI for further evaluation.
Areas of hypoattenuation in the left cerebellum concerning for infarct, technically age indeterminate in the absence of prior comparisons but favored remote given low density.

Hyperdense ovoid intraparenchymal hemorrhage centered at the left putamen measuring 7x4mm with surrounding hypoattenuation suggestive of vasogenic edema. Findings are concerning for hypertensive hemorrhage of the left basal ganglia.

No midline shift, no extra-axial collection, no herniation.
Cerebral atrophy.

Acute intraparenchymal hemorrhage of the left basal ganglia with mild vasogenic edema and mild effacement of the left lateral ventricle. There is no hydrocephalus.

Acute intraparenchymal hemorrhage centered in the left basal ganglia meausuring X mm (X mL) with associated mass effect and surrounding vasogenic edema. Given its location, hypertensive hemorrhage is high on the differential. No evidence of herniation, mass lesion, or hydrocephalus.

Generalized cerebral and cerebellar volume loss with ex vacuo dilatin of the ventricles. There are area of encephalomalacia whiht the right MCA territory and left cerebellum suggestive of prior (old) infarcts.

Intraparenchymal hemorrhage in the left basal ganglia with possible layer blood in the occipital horns representing intraventricular extension.

cm x cm intraparenchymal bleed centered within the left lentiform nucleus with moderate surrounding vasogenic edema. This results in local sulcal effacement, mass effect on the left lateral ventricle, and x mm rightward shift.

Acute intraparenchymal hemorrhage centered on the left lentiform nuclus with mild surrounding vasogenic edema and associated mass effect on the left lateral ventricle and minimal rightward midline shift. No hydrocephalus. No tonsilar herniation. Likely hypertensive in etiology.

Hypoattenuating lesion of the right temporoparietal lobe, possibly representing chronic infarct with surrounding encephalomalacea of the right temporal lobe. Remote infarcts of the left occipital lobe and left cerebellar hemisphere watershed.

Acute left basal ganglia hemorrhage. Recommend CTA for further evaluation.
Multiple remote infarcts in the cerebellum and right MCA territory.

Acute intraparenchymal hemorrhage centered in the left lentiform nucleus measuring xx x xx x xx. Surrounding hypoattenuation compatible with vasogenic edema. No midline shift. minimal adjacent local mass effect with crowding of the left frontal sulci. Hypertension favored etiology

Background CT old brain stuff. Remote bilateral cerebellar infarcts.

Acute intraparenchymal hemorrhage centered in the left basal ganglia concerning for hypertensive bleed. There is surrounding edema and mild local mass effect.

Acute intraparenchymal hematoma centered within the left basal ganglia favored to be hypertensive in etiology. There is mild surrounding vasogenic edema with mild effacement of the left lateral ventricle without overt evidence of midline shift.

Multiple areas of loss of gray-white differentiation involving the right greater than left MCA territories concerning for age-indeterminant infarcts. If there is concern for acute ischemia, MRI w/o contrast could be obtained for further evaluation.

Acute intraparenchymal hemorrhage along the L basal ganglia with surrounding vasogenic edema.

moderate size intraparenchymal hemorrhage involving the left putamen and globus pallidus with extension superiorly into the left corona radiata. there is mild surrounding vasogenic edema with sulcal effacement and mild effacement of the left lateral ventricle. no herniation or midline shift. there is diffuse atrophy with sulcal prominence, likely age related with mild hydrocephalus ex vacuo. scattered areas of encephalomalacia in the left temporal lobe and bilateral cerebellar hemispheres, which may represent sequelae from prior infarct

hypertensive bleed involving the left basal basal ganglia and periventricular white matter

Acute intraparenchymal hemorrhage measuring _ x _ x _ cm (estimated volume _ mL) centered within the left basal ganglia with a linear focus of high density extending superiorly from the posterior margin of the dominant hemorrhage into the left caudate body. There is mild surrounding parenchymal hypoattenuation compatible with vasogenic edema, with associated mass effect resulting in asymmetric sulcal effacement of the left temporal lobe, mild effacement of the left lateral ventricle, and minimal leftward midline shift. No large vascular territory infarct, extra-axial hemorrhage, intraventricular extension, or hydrocephalus.

Background of chronic small vessel ischemic disease and global parenchymal atrophy with ex vacuo ventricular dilatation.

Large hyperdense (acute) hemorrhage in the left putamina. There is minimal left to right midline shift. Basal cisterns are patent. slight left to right midline shift.

L basal gangl IPH with surrounding vasogenic edema

intraparenchymal hemorrhage in the left external capsule
ex vacuo dilatation of the ventricles
mild left to right midline shift
chronic infarcts in the cerebellum and right parietal lobe

Left basal ganglia or thalamic IPH with surrounding vasogenic edema and rightward midline shift. The lateral ventricles are enlarged. No mass lesion. No displaced fracture.

Acute intraparenchymal hemorrhage measuring x by x by x centered in the left basal ganglia with surrounding vasogenic edema resulting in x left to right midline shift. No hydrocephalus or herniation.
Remote left cerebellar infarcts.