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There is a large (45 mm) acute haematoma in the region of the left insula/ basal ganglia extending superiorly into the left frontal white matter. Inferiorly the haematoma is in close proximity to the MCA trifurcation. No unequivocal aneurysm can, however, be identified on the non-contrast CT. Intraventricular extension is evident into the left lateral ventricle. There is mass effect with effacement of the of the lateral left lateral ventricle and 3 mm midline shift to the left. There is also a early effacement of the basal cisterns. No other focal cerebral lesions. The contents of the posterior fossa appear normal. No osseous abnormality within the skull base or calvarium.
Large acute haemorrhage within the left basal ganglia/insula tracking superiorly into the frontal white matter. There is moderately severe mass effect with midline shift and early effacement of the basal cisterns. Clearly in a patient of this age an underlying vascular malformation or aneurysm are highly likely and dedicated intracranial vascular imaging will be required.