A large (6 x 3 x 4 cm) left temporal lobe intra axial lesion demonstrates heterogenous T2 signal, peripheral T1 hyperintensity, and marked T2*GRE susceptibility artefact.
The lesion exerts significant local mass effect with surrounding sulcal effacement. Secondary subfalcine and early transtentorial brain herniation; right subfalcine midline shift (5 mm), mesial temporal lobe shift and cerebral peduncle compression, and mid brain shift.
The left transverse sinus is brightly T1 and T2 hyperintense and the phase-contrast MRV demonstrates complete absence of flow.
Conclusion
Left transverse sinus thrombosis. Associated left temporal lobe haemorrhagic venous infarct with significant mass effect and brain herniation.