Case 22 - Hypertensive Bleed, IPH with IVH, Case 2: CT

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: CT HEAD WO CONTRAST STROKE PROTOCOL

INDICATION: Stroke symptoms.

TECHNIQUE: CT of the head was performed without intravenous contrast.

COMPARISON: None.

FINDINGS:

Examination is motion degraded.

Acute intraparenchymal hematoma centered in the left thalamus and corona radiata, measuring approximately 2.3 x 3.1 x 3.0 cm (TV x AP x CC). There is intraventricular extension of hemorrhage which partially fills the left lateral ventricle body, atrium, and occipital and temporal horns. Mild surrounding vasogenic edema with mass effect, partially effacing the third ventricle and left lateral ventricle. There is rightward midline shift at the level of the third ventricle, measuring approximately 1-2 mm.

Basal cisterns are patent, to the limits of the examination.

Gray-white matter differentiation is grossly maintained, without evidence of territorial infarct. Patchy hypoattenuation in the periventricular and subcortical white matter is nonspecific, but suggestive of chronic microvascular ischemic changes. There is mild global cerebral volume loss with prominence of CSF spaces. The ventricular system is mildly enlarged, proportionate to the degree of parenchymal volume loss.

The orbits and paranasal sinuses are suboptimally evaluated. The mastoid air cells are largely well aerated. Evaluation of the calvarium and soft tissues is within normal limits, allowing for artifact.

IMPRESSION:

Motion limited exam. Acute intraparenchymal hematoma in the left thalamus and corona radiata, likely hypertensive in etiology. There is intraventricular extension to the left lateral ventricle. Mild mass effect with effacement of CSF spaces and minimal rightward midline shift.Indication: Follow-up intracranial hemorrhage.

Technique: Axial CT scan images were performed from the foramen magnum to the vertex without administration of intravenous contrast.

Findings:

These images demonstrate an area of hemorrhage centered in the left thalamus with associated intraventricular hemorrhage bilaterally. There is mass effect at the level of the third ventricle with midline shift measuring approximately 3 mm.

Periventricular white matter hypodensity is also present bilaterally.

When compared with the prior examination at 11:28 AM the size of the hemorrhage is unchanged. The amount of intraventricular blood has increased slightly in the right occipital horn. The ventricle size has slightly increased.

IMPRESSION:

Although the parenchymal hematoma in the left thalamus has not changed in size, there is slightly greater intraventricular hemorrhage and slight increase in the ventricular size. Recommend continued short-term follow-up. Based on the location, this is most likely hypertensive in etiology.