Early subacute intracerebral hypertensive bleed

There is early subacute intraparenchymal bleed measuring ~2.1 x 1.2cm involving posterior aspect of left gangliocapsular region and adjoining centrum semiovale. It appears predominantly hypointense on T1W, hyperintense on T2W and demonstrates marked susceptibility artifact on gradient echo images. Mild FLAIR hyperintense perifocal vasogenic edema is present. Minimal mass effect with partial effacement of left sylvian fissure and trigone of left lateral ventricle noted.

Multiple punctuate foci demonstrating blooming on GRE/SWI images are seen in bilateral cerebral white matter, thalami and pons - suggestive of chronic microbleeds.

Multiple small discrete and confluent T2W/FLAIR hyperintensities are seen in bilateral frontoparietal subcortical and periventricular white matter with no DWI restricted diffusion - suggestive of chronic microvascular ischemic changes.

Small T2W hyperintense chronic lacunar infarcts are seen in bilateral thalami, corona radiata and pons.

Early subacute intracerebral hypertensive bleed with chronic Hypertensive Encephalopathy, mild chronic periventricular white matter microvascular ischemic changes and multiple chronic lacunar infarcts.