50 yo F with history of methamphetamine use presenting with AMS and headache.
1. Right frontoparietal intraparenchymal hematoma with extensive intraventricular hemorrhage. Effacement of basal cisterns with bilateral downward herniation. Concern for underlying lesion resulting in hemorrhage, including vascular malformation, mycotic aneurysm, and neoplasm. Recommend follow-up MRI with and without contrast and MRA following resolution of hematoma to evaluate for these lesions.
2. Asymmetric enlargement of left lateral ventricular system, concerning for developing non-communicating hydrocephalus.
(Ruptured arteriovenous malformation)