Lobar hemorrhage secondary to cerebral amyloid angiopathy

Right superior frontal lobar hematoma that abuts the falx cerebri, just superior to the right lateral ventricle, associated with hyperdense right parafalcine and tentorial SDH. The hematoma is surrounded by moderate vasogenic edema. There is associated mass effect with sulcal effacement, predominantly in a right cerebral hemisphere.

On the T1 weighted images, the hematoma is demonstrated the right frontal lobe (superior frontal gyrus) with extension into the right parafalcine subdural space. Post-contrast images demonstrates a thin rim of enhancement surrounding this hematoma. In addition, there is a larger component is seen anterior to the hemorrhage which also demonstrates contrast enhancement. This area of enhancement abuts the right falx and laterally, there is a satellite nodule of enhancement.

There is susceptibility artefact related to the hemorrhage. No other focus of cortical cyst to the artefact is detected. Adjacent increased T2 hyper intensity which affects the right frontal and parietal lobes.

Diffusion weighted images demonstrates diffusion restriction of the hematoma itself. The enhancing component is not demonstrate diffusion restriction. Time of flight MRA (not shown) did not cover the region of hemorrhage.

Conclusion: Right frontal hemorrhage. There is likely underlying lesion, morphology consistent with a glial series tumor (most likely high grade). Metastasis cannot be entirely excluded. High grade stenosis of the left extracranial internal carotid artery.