Large lobar intracerebral haematoma involving the right temporal lobe with a small amount of surrounding perihaematomal oedema. Subarachnoid haemorrhage in the overlying sulci as well as the basal cisterns. Right subdural haematoma. Small volume intraventricular haemorrhage in the fourth ventricle.
There is diffuse effacement of the cortical sulci, effacement of the right lateral ventricle, marked leftward midline shift, right uncal and central transtentorial herniation and effacement of the basal cisterns. Tonsillar herniation is present. No hydrocephalus.
Small ovoid lesion immediately inferior to the haematoma, adjacent to the expected location of the middle cerebral artery is suggestive of an aneurysm, which is the likely cause of the haemorrhage.
Low attenuation in the inferomedial right parietal and occipital lobes with loss of grey-white matter differentiation is concerning for an acute posterior cerebral artery infarct. The brainstem is difficult to assess due to streak artefact but its attenuation also appears reduced, which is suggestive of infarct.