Left-sided craniectomy and overlaying extra-axial collection with fluid and blood products are again demonstrated. The left occipital lobe intraparenchymal haemorrhage is unchanged in size and amount of surrounding vasogenic oedema. There is a slightly prominent cortical vessel that runs close to the posterior superior sagittal sinus and shows a bulkier component abutting the left occipital parenchymal haemorrhage; also, some signs of high flow within the superior sagittal sinus is noted on the MRA TOF. Additionally, there is the prominence of the left posterior auricular artery with apparent transosseous branches to the left transverse sinus. The haematomas along the cerebral falx, tentorium, prepontine cistern, floor of the anterior cranial fossa on the left, and overlaying the left temporal lobe have remained overall unchanged compared to the last CT. Rightward midline shift of 6 mm is stable. Circle of Willis MRA is degraded by motion artefacts and of limited assessment.
Conclusion: Imaging features raise the suspicion for an underlying vascular malformation, particularly a left dural arteriovenous fistula. Further DSA study is recommended. Intracranial haematomas are overall unchanged since the previous scan.