Interval increase in numerous foci of blooming noted in bilateral frontal lobes s/o sub-acute to chronic bleeds.
A well-defined T1 and T2 hyperintense foci with blooming and hemosiderin rim measuring 1.1 x 0.7 cm is noted in the right frontal parenchyma, likely subacute hematoma.
Prominent frontal peri-medullary veins draining into the deep venous system through ependymal veins is re-demonstrated on SWI and post-contrast images.
Thick patchy to linear enhancement is noted involving bilateral frontal parenchyma and pachymeningeal enhancement is seen along the interhemispheric fissure. Sulcal meningeal/subpial enhancement seen in bilateral frontal and occipital regions(left > right).
Prominent lacunes are noted with non-specific juxta cortical WM changes.
Diffuse subcortical FLAIR hypointensity was noted in the bilateral frontal parenchyma.
Impression:
In view of interval increase in hemorrhagic components and persisting pachymeningitis, granulomatous vasculitis with disease progression was considered.