Findings:
There is an intraparenchymal hemorrhage centered in the right caudate head and anterior limb of the internal capsule. There is intraventricular extension with blood products noted in the right frontal horn, right lateral body, third ventricle, bilateral occipital horns, and fourth ventricle. There is clot seen within the region of the cerebral aqueduct. There is asymmetric dilatation of the lateral ventricular system suggesting early obstructive hydrocephalus.

There is severe chronic small vessel ischemic disease and ex vacuo dilatation of the ventricles.

There is mild surrounding edema with mass effect on the right frontal horn with mild right to left midline shift measuring approximately 3mm.

There are atherosclerotic calcifications of the bilateral carotid siphons.

There is mild mucoperiosteal thickening of the left maxillary, bilateral ethmoid, and bilateral sphenoid sinuses.

Impression:
Intraparenchymal hemorrhage centered in the right basal ganglia with significant intraventricular extension. This is consistent with a hypertensive etiology.

Recommendations:
For your training purposes, recommendations are not included in this report.