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CT Head Thalamic Hemorrhage

Technique: Noncontrast helical images of the head were performed.
Findings: There is a 1.4 cm hyperdense hemorrhage centered in the right thalamus, with mild surrounding vasogenic edema. Confluent hypodensity in the supratentorial white matter is consistent with small vessel ischemic change. Small CSF signal intensity lesion in the left periventricular white matter extending inferiorly into left putamen is consistent with an old lacunar infarct. Similar finding is noted adjacent to the left caudate head. There is no hydrocephalus. There is no subdural, epidural or subarachnoid hemorrhage on the exam. Dense posterior falx calcification is likely dystrophic in etiology, though a heavily calcified en plaque meningioma would have a similar appearance. Degenerative changes are noted at the cranial cervical junction. There is no aggressive lytic or blastic calvarial lesion noted.

Impression: Small right thalamic hemorrhage, possibly hypertensive. Other senescent ischemic findings as above.

Findings: There is a new hyperdense hemorrhage centered in the right thalamus measuring approximately 3 cm in diameter with some extension into the posterior horn of the right lateral ventricle. There is no significant mass effect, herniation or hydrocephalus. Senescent changes to include diffuse parenchymal atrophy, chronic appearing microangiopathic changes in the supratentorial white matter and cavernous carotid artery calcifications are unchanged. The paranasal sinuses, orbits, and calvarium are unremarkable.

Impression: Acute right thalamic hemorrhage most likely secondary to hypertensive angiopathy. Recommend neurosurgery consultation.