Large left-sided intracerebral haematoma. It involves both deep and lobar structures. Its epicentre is within the left frontal white matter. The haemorrhage extends into the intraventricular spaces, but there is no clear subarachnoid or subdural haemorrhage. The haematoma is irregular but there are no finger-like projections. Centrally within the haematoma is a well-defined area of hypoattenuation not connected with the surrounding brain parenchyma, consistent with a black hole sign.
There is significant mass effect relating to the haematoma and perihaematomal white matter oedema causing midline shift, compression of the ipsilateral lateral ventricle and third ventricle and effacement of ipsilateral cortical sulci. There is dilatation of the temporal horns of the lateral ventricles in keeping with hydrocephalus.
Severe periventricular low attenuation is probably in keeping with small vessel disease. Moderate to severe cortical atrophy.