A left cerebellar hemisphere acute haemorrhage is demonstrated, measuring 4 x 2.5 x 2.5 cm, with extension into the extra-axial space, with this component measuring 13 mm in depth. The overall effect is effacement of the posterior fossa basal cisterns and 4th ventricle, with enlargement of the 3rd and lateral ventricles consistent with developing hydrocephalus.
Extensive patchy white matter hypoattenuation is in keeping with chronic small vessel ischaemic change.
CTA arch to vertex:
Intradural vessels demonstrate no focal abnormality, specifically no evidence of avascular malformation or aneurysm related to the aforementioned left cerebellar hemisphere haemorrhage. No evidence of arteriovenous shunting to suggest a malformation or dural arteriovenous fistula.
Incidental note is made a somewhat ectatic right extradural cavernous ICA, without defined aneurysm. Note is also made of both posterior inferior cerebellar arteries arising from the vertebral arteries at or just prior the entry through the dura.
The extracranial circulation is largely unremarkable, with only moderate stenosis of the left internal carotid artery origin (50-65%).
Minor multilevel degenerative change of the cervical spine is demonstrated, with no high-grade stenosis. Soft tissues of the neck are within normal limits.
Conclusion:
1. Left cerebellar hemispheric haemorrhage with extra-axial extension in this clinical context (known poorly controlled hypertension) presumably represents a primary hypertensive haemorrhage. No underlying vascular abnormality evident.
2. developing hydrocephalus
3. moderate left ICA stenosis at it origin