Assessment #2 set #1 case #4

test

Left intraparenchyal hemorrhage centered around insula. SAH along there/parietal and right insula. Query trace blood along lateral ventricles. recommend cta

Sulcal effacement without midline shift.

L frontotemporal intraparenchymal hemorrhage
SAH in the bilateral sylvian fissures and basal cisterns.

Acute moderate volume subarachnoid hemorrhage with highest focus of blood products demonstrated within the left sylvian fissure and suprasellar cistern. Subarachnoid blood products are also demonstrated throughout the basal cisterns, anterior interhemispheric fissure, and right sylvian fissure, as well as a small volume of sulcal subarachnoid blood products overlying the left frontoparietal cerebral convexity. Mixed attenuation of blood products within the anterior aspect of the left sylvian fissure raises concern for hyperacute hemorrhage, with etiology most likely aneurysmal in nature, likely arising from the left MCA bifurcation. No significant mass effect, midline shift, or herniation. Recommend neurosurgical consultation and CTA head for further evaluation.

Intraventricular hemorrhagic extension is visualized within the fourth ventricle. No findings concerning for acute hydrocephalus at this time.

Acute multicompartmental hemorrhage: SAH layering over left cerebral convexity sulci, basal cisterns, 4th ventricle. left basal ganglia hemorrhage

acute SAH throughout left cerebral hemisphere, interpeduncular fossa, ambient cisterns w/o evidence of hydro or IVH. no definitive iph identified.

small hypoattenuating, well rounded structure in the sylvian fissure in the expected region of the left mca bifurcation c/f aneurysm.

Acute subarachnoid hemorrhage layering in the left > right sylvian fissures and basal cisterns, and left cerebral convexity sulci. Local mass effect is present without midline shift or herniation. Soft tissue density at the M1/M2 junction may represent aneurysm as origin of hemorrhage. Recommend CTA head for evaluation.

Acute parenchymal hemorrhage centered in the left insular region, measuring approx x, volume x. Subarachnoid hemorrhage noted along the sylvian fissures bilaterally, in the basal cisterns, and along the left greater than right cerebral sulci. Mild associated sulcal effacement, no midline shift. No hydrocephalus at this time. In the absence of trauma, findings may represent sequelae of ruptured aneurysm. Recommend CTA and/or catheter angiography for further evaluation.

No evidence of acute large vasc territory infarct.

Acute IPH measuring xx with est volume xx centered in the left temporal lobe. MIld surrounding edema with sulcal effacement. Small volume SAH layering in the sulci of the bilateral, left greater than right, cerebral hemispheres as well as in the basal cisterns.

No midline shift or herniation.

Etiology could relate to amyloid angipathy, however given locaiton hemorrhagic herpes encephalitis should also be a consideration. Recc further eval with MRI brain.

Inraparenchymal hematoma measuring X centered over the left basal ganglia and external capsule. Additional SAH involving the bilateral sylvian fissures and suprasellar/basilar cisterns. Relative loss of sulci throughout concerning for increased brain swelling. No midline shift or hydrocephalus. No large vascular territory infarct.

Acute large volume SAH in the left greater than right sylvian fissure with extension into the basal cisterns and throughout the left cerebral convexity sulci. Associated acute IPH in the inferior left temporal lobe measuring x mm x x mm (volume). Associated IVH with acute hemorrhage in the fourth ventricle. Findings concerning for ruptured aneurysm, recommend CTA or DSA for further evaluation. No evidence of hydrocephalus at this time. Diffuse sulcal effacement with possible mild effacement of the basal cisterns. Possible trace rightward midline shift measuring xmm. Mild crowding of the cerebellar tonsils without herniation at this time.

Scatted multicompartmental subarachnoid hemorrhage centered in the bilateral sylvian cisterns and basal cisterns. Additional hemorrhage diffusely within the sulci of the cerebrum with associated sulcal effacement. Moderate subarachnoid hemorrhage in the left temporal lobe. Hemorrhage within the 4th ventricle with associated crowding at the foramen magnum concerning for impending tonsillar herniation.

Consider CTA for possible underlying ruptured aneurysm.

Large MCA bifurcation anurysm with adjacent acute IPH in the anterior left temoral lobe and left frontal lobe with extraxial extension with SAH in the left greater than right sylvian fissures, along the high left frontal and left parietal lobes, interpeduncular fossa, basilar cisterns, and 4th ventricle.
Diffuse cerebral edema with diffuse sulcal effacement, left worse than right.
complete effacement of the basilar cisterns.
No midline shift. No large vascular territory infarct. no hydrocephalus

-SAH hemorrhage most concentrated in the left sylvian fissure around circular structure concerning for MCA aneurysm.
-Left to right midline shift measuring X
-No hydrocephalus
-No evidence of large vascular territory ischemia.

Large volume subarachnoid hemorrhage layering throught the bilateral sylvian fissures, basilar cisterns, interpeduncular fossa, quadrigeminal plate cisterns, as well as the high left frontoparietal sulci. In addition there is a circular hypoattenuation at the anterior aspect of the left sylvian fissure , near the proximal M2 branch, which may represent an aneurysm. Recommend CTA and neurosurgical consult.

The brain appears globally hypoattenuated, but with grey white matter differentiation intact.

No acute hydrocephalus. No blood layers within the ventricles.

Trace mass effect with sulcal effacement of the left hemisphere. Trace midline shift (measure). Crowding at the foramen magnum with no definitive herniation.

Acute SAH predominantly centered in the L sylvian fissure with smaller volume of hemorrhage in the basal cistern and R sylvian fissure. There is associated edema with sulcal effacement there is effacement of the basal cisterns. Slight rightward midline shift. The location is concerning for ruptured MCA aneurysm. Recommend CTA for further evaluation.

Left greater than right subarachnoid hemorrhage of the basal cisterns and layering within the left greater than right sylvian fissures with extension into the 4th ventricle.

Intraparenchymal hemorrhage measuring x of the left temporoparietal lobe, as well as linear scattered subarachnoid hemorrhage within the left hemispheric sulci with sulcal and basal cistern effacement and x rightward midline shift. Crowding of the basal cisterns and foramen magnum with concern for downward transtentorial uncal and tonsillar herniation, respectively. No hydrocephalus.

Bilateral, Left greater than right, SAH within the sylvian fissures. This finding could be concerning for aneurysm rupture, recommend CTA for further evaluation. No hydrocephalous, ischemia, or midline shift.
No acute osseous abnormalities.

Acute intraparenchymal hemorrhage measuring X mm (Volume) centered in the left insula with associated vasogenic edema mild mass effect (local sucal effacement). There is extensive subarachnoid hemorrhage as well. THese findings are suggestive of an aneurysmal hemorrhage. Given the location, a mycotic aneurysm should be considered. No evidence of large vascular territory infarct or herniation.

Left p Hemorrhage. Sub A hemorrhage. Recommend CTA.

Acute IPH in the left frontal and temporal lobes with estimated volume of ***. Rounded hyperdense lesion anterior and slightly medial to the IPH in the expected area of the left MCA is concerning for vascular lesion. Recommend CTA head/neck for further evaluation.

Scattered SAH along the bilateral sylvian fissures, high left frontal sulci, and basal cisterns.

Mass effect with generalized effacement of sulci and partial effacement of the basal cisterns. No obstructive hydrocephalus. No midline shift.

No large territory infarct.

subarachnoid hemorrhage layering in left grease rhtna right sylvan, concerning for MCA aneurysm and rupture. CTA could further evaluate

Acute parenchyma hemorrhage within the left temporal lobe measuring and moderate volume subarachnoid hemorrhage layering within the left greater than right syviliian fissures and overlying the cerebral sulci. additional hemorrhage within the 4th ventricle.

diffuse sulcal effacement and effacement of the basal cisterns raises concern for cerebral edema.

These findings are concerning for aneurysm rupture. Reccomend CTA.

Acute multicompartmental hemorrhage with intraparenchymal hematoma within the left temporal lobe measuring x by x cm (volume) and possible punctate foci of acute hemorrhage in the left basal ganglia and subarachnoid hemorrhage within the left parietal and left greater than right temporal lobes with extension into the sylvian fissures bilaterally and suprasellar cisterns bilaterally and fourth ventricle. Findings are concerning for ruptured aneurysm. Recommend emergent neurosurgery consult and CTA head and MRI without contrast for further evaluation.

Marked surrounding edema results in supra and infratentorial sulcal effacement with trace right to left midline shift, crowding of the basal cisterns, and possible cerebellar tonsillar herniation. No definite hydrocephalus although attention on close follow up.

Intracranial atherosclerosis.

Incidental calcified meningioma along the anterior falx.

acute subarahcnoid hemorrhage in the L>R sulci t/o the temporal and parietal lobes and the sylvian fissure. Small volume blood products in 4th ventricle. no acute hydro.
no infarct. Rec CTA for further eval.

subarach

L ant temporoparietal IPH w/ SAH throughout L convexity, b/l insular sulci, and basilar cisternae. Mild R midline shift. Rec CTA to look for aneurysm.

Moderate SAH layering along the L > R sylvian fissure and high b/l frontoparietal sulci, interhemispheric fissure, and suprasellar cistern. Round hyperattenuating structure adjacent to the left sylvian fissure may represent aneurysm. Overall findings suggestive of aneurysmal SAH, with possible source left MCA given distribution of SAH. Recommend CTA for further evaluation.

Questionable hemorrhage extension into the 4th ventricle vs calcified choroid plexus.

No overt signs of hydrocephalus, but attention on follow up.

left sylvian fissure SAH with ap x tv x cc intraparanchymal hematoma in the left temporal lobe. No midlien shift or mass effect. Small hemm lining the suprasellar cystern and 4th ventricle. No signs of acute hydro. Left MCA dense ovioid hyperattenuation may rep aneurysm .

Intraparychemal hemorrhage centered in the left temporal lobe with associated left greater than right diffuse subarachnoid hemorrhage, concerning for MCA aneurysm rupture (especially given evidence of prior coiling of Acomm aneurysm).

Large volume subarachnoid hemorrhage is greatest within the left Sylvian fissure, as well as throughout the basal cisterns, suprasellar cistern, and right Sylvian fissure. Trace intraventricular hemorrhage within the fourth ventricle. No hydrocephalus. Diffuse suclal effacement, crowding of the cisterns, with tonsillar herniation. Findings raise concern for aneurysmal bleed, recommend CTA for further evaluation.

Acute SAH, mostly layering in left sylvian fissure, but with blood products also noted in the prepontine cistern.

Large volume subarachnoid hemorrhage with distribution concerning for left MCA aneurysm rupture. Parafalcine calc vs calcified meningioma.

Left intraparenchymal hemorrhage.

Subarachnoid hemorrhage along the body of corpus callosum, left greater than right corona radiata, temporal lobe and in the fourth ventricle.

no evidence of hydrocephalus or herniation.

Subarachnoid hemorrhage secondary to a ruptured large aneurysm in the M2 branch of the right MCA. Hemorrhage extends into the fourth ventricle.
Minimal right-to-left midline shift. Diffuse effacement of the sulci and intracranial cisterns is noted.

Acute subarachnoid hemorrhage in the sylvian fissures, left greater than right.

Acute subarachnoid hemorrhage originating from the left MCA territory with questionable aneurysm of the left MCA bifurcation.

Subarachnoid blood products involving both sylvian fissures, interhemispheric fissures, and basal cisterns without hydrocephalus. There are questionable blood products within the fourth ventricle.

There is lateral deviation of the right orbit. Consider neurological correlation for ophthalmoplegia.

Acute intraparenchymal hemorrhage in the left temporal lobe with superior extension into the left basal ganglia. Mild localized sulcal effacement. No midline shift.
Subarachnoid hemorrhage is present along the bilateral sylvian fissures and lateral convexity gyrus.

Hyperdense formation in left parietal/temporal lobe as well as fine hyperdense formation in the subarachnoid space of both brain hemisphares

Acute supratentorial subarachnoid hemorrhage with left greater than right hemorrhage in the sylvian fissures, anterior hemispheric fissure, basal cisterns, and scattered gyriform SAH in the high frontal lobes. This pattern of SAH is suspicious for aneurysmal rupture. Effacement of the suprasellar cisterns and CSF cisterns surrounding the midbrain concerning for tonsillar herniation.

There is prominence of the temporal horns, slight rounding of the 3rd ventricle concerning for early hydrocephalus.

Hyperattenuating lesion in the left temporal lobe measuring xx by xx by xx (volume) compatible with intraparenchymal hemorrhage. Adjacent mass effect with sulcal effacement. May represent AVM vs ruptured aneurysm. Hemorrhagic neoplasm less likely. No midline shift. MRI and CTA to further assess.

Subarachnoid hemorrhage along the L>R sulci, bilateral sylvian fissures, anterior interhemispheric fissure, and basal cisterns. Hemorrhage in the fourth ventricle.

Prominence of ventricular system. concerning for communicating hydrocephalus

Acute intraparenchymal hemorrage measuring x b x b x resulting in y volume with extensions into the bilateral sylvian firssures, multiple left greater than right sulci, the basal cisterns, and hemorrhag ein the left lateral ventricle, 3rd ventricle and 4th ventricle. Findings are concerning for an acute aneurysm rupture. Reccomend CTA head anc neck for further evlauation.

There is significant mass effect with left greater than right sulcal effacement. Rounding of the 3rd ventricles is concerning for developing hydrocephalus.

Large volume subarachnoid hemorrhage layering the left greater than right sylvian fissures, throughout the basal cisterns, and layering throughout the left cerebral sulci. Additionally, there is a small focus of hemorrhage within the 4th ventricle. Mass effect from the hemorrhage results in slight left to right midline shift, effacement of the cerebral sulci and crowding of the foramen magnum which is concerning for cerebellar tonsillar herniation. Abnormal ballon like contour of the left MCA at the division between the M1 and M2 segments is suspicious for underlying aneurysm as the etiology for this hemorrhage. Recommend further evaluation with CTA.

There is slight rounding of the third ventricle without substantial enlargement of the temporal horns of the lateral ventricles which may indicate early developing hydrocephalus. Attention on follow-up is recommended.

Multifocal acute SAH involving the basal cisterns, bilateral left greater than right sylvian fissures, layering over the sulci of the bilateral cerebral convexities with interventricular extension to the level of the fourth ventricle. Additional intraparenchymal hemorrhage noted in the left temporal lobe. Adjacent sulcal effacement, mass effect and mild left to right midline shift. Recommend CTA for further evaluation.

There is tonsillar herniation and effacement of the basal cisterns concerning of developing transtentorial herniation.

Subarach hem predominately at left sylvian fissure and at basal cisterns concerning for ruptured aneurysm. Recommend CTA.

Multifocal large volume SAH layering within the L greater than R sylvian fissures and basal cisterns. There is mild local sulcal effacement without midline shift. No hydrocephalus.

Acute aneurysmal SAH is demonstrated predominantly in the left sylvian fissure and to a lesser extent the right sylvian and interhemispheric fissure. Probable left MCA or terminus aneurysm. Cerebral DSA is recommended.

Axial CT head is present. Right frontal parafalcine calcification is present. Subarachnoid hyperdensities are present in bilateral sylvian fissures, basal cisterns, and frontoparietal fissures, left greater than right. There is mild hyperdensity of the basilar artery tip. Blood products are present in the fourth ventricle. Gray-white differentiation is maintained. The insular ribbons are intact. No acute soft tissue or osseous abnormalities are present. The ventricles are normal in size. No midline shift. No visualized herniation.

Impression:
1. Subarachnoid hemorrhage in bilateral sylvian fissures, basal cisterns, and around the frontoparietal fissures, left greater than right. This appearance can be seen in basilar tip aneurysm rupture.
2. Intraventricular hemorrhage in the fourth ventricle.
3. Right parafalcine calcification is favored to represent a meningioma.

There is subarachnoid blood within the right greater than left sylvian fissures extending into the basal cisterns and the 4th ventricle. There is a hypodensity at the right MCA trifurcation suggestive of an aneurysm. Together these findings are suggestive of a ruptured aneurysm. There is effacement of the left temporal horn of the lateral ventricle and the lateral aspect of the 4th ventricle. Recommend CTA head and neck for further evaluation, and emergent surgical consult.

Mixed density intraparenchymal hemorrhage of the LEFT frontotemporal region.

Subarachnoid hemorrhage of the LEFT frontoparietal region.

Possible RIGHT frontal intraparenchymal hemorrhage.

kjjnkjn

–

Left inferior temporal lobe hemorrhage with extension into the subarachnoid space in the Silvian fissure