Haematoma within the posterior right frontal superior gyrus and the paracentral lobule is again demonstrated. There is involvement of the right motor strip. There is a small amount of surrounding oedema. Mass-effect results in adjacent sulcal effacement. Nodular areas of contrast enhancement are present on the postcontrast images around the periphery of the lesion. Abnormal diffusion restriction in keeping with haematoma. FLAIR hyperintensity in the left history cingulate gyrus in keeping with the previously demonstrated subarachnoid haemorrhage. There is equivocal wispy but no definite nodular enhancement in this region on post contrast stereotaxis image.
No other enhancing lesions are identified. Deep and periventricular white matter changes in keeping with chronic small vessel ischaemia.
Conclusion:
Posterior right frontal haematoma with nodular enhancement is highly suspicious for an underlying lesion, and in clinical context metastatic melanoma should be considered.