I've missed more than 9000 shots in my career. I've lost almost 300 games. 26 times, I've been trusted to take the game winning shot and missed. I've failed over and over and over again in my life. And that is why I succeed."
~ Michael Jordan
Obs of a Prnnl Lrnr Obsrvr who happens to be a dctr There is no cure for curiosity-D Parker
I've missed more than 9000 shots in my career. I've lost almost 300 games. 26 times, I've been trusted to take the game winning shot and missed. I've failed over and over and over again in my life. And that is why I succeed."
~ Michael Jordan
Self doesn’t consist of anything. Show me ‘self.’ Show me either the physical or non-physical self. Go looking for this ‘self’ and it will be clear there is no such thing. ‘Self’ is just a concept.
“There is no entity by name mind or ‘self.’ Because of the emergence of thoughts we surmise something from which they start. That we term ‘self.’ When we probe to see what it is, there is nothing like it. The fact is that what we call ‘self’ is only a bundle of thoughts….with no thinker” - Ramana Maharshi
There appears to be a real ‘organism’ (body,) but there’s no ‘self’ inside.
And at the Absolute level, even the apparent body form and ‘world’ are just illusory projections - like your dreams.
All just free wild energy, simultaneously forming and evaporating into formlessness, with no static ‘self’ inside.
Based on that CT report + the clinical history (sunsetting eyes, lethargy, raised BP, ?raised ICP), the top 3 differentials for the cause of this pattern of haemorrhage are:
Why it fits:
The haemorrhage is centred in the quadrigeminal cistern / perimesencephalic cistern, which is a classic subarachnoid location.
There is intraventricular extension (blood in lateral + 3rd ventricles), which can happen with aneurysmal SAH.
Obstructive hydrocephalus is very common after SAH/IVH.
No trauma features → makes spontaneous SAH more likely.
Most likely aneurysm territories in this region:
Posterior circulation aneurysms (e.g. basilar tip, PCA, SCA).
Why it fits:
AVMs or fistulas can cause large-volume haemorrhage, including subarachnoid + intraventricular blood.
Posterior fossa / deep midline vascular lesions can bleed into cisterns and ventricles.
This is especially important in neonates/infants where vascular causes are a key concern.
Clue in the report:
They explicitly recommend MRI/US “for evaluation of underlying vascular or structural abnormality” — that’s radiology code for “we’re worried this could be vascular.”
Why it fits:
The report strongly suggests this is a neonate (“neonatal intensive care input”, cranial ultrasound).
Neonatal IVH can cause acute obstructive hydrocephalus, lethargy, sunsetting eyes, and raised BP (Cushing response).
Although classic germinal matrix IVH is more anterior (caudothalamic groove), severe IVH can track widely through the ventricles and cause secondary cisternal blood.
Why it’s slightly less perfect than #1–2:
The centre of haemorrhage being described as quadrigeminal/perimesencephalic cistern is more “subarachnoid-first” than “ventricular-first.”
Urgent neurosurgical review (likely CSF diversion: EVD/VP shunt depending on stability).
Cranial ultrasound (fast bedside).
MRI brain ± MRA/MRV when stable.
Often CTA/MRA is considered specifically to look for posterior circulation aneurysm/AVM.
If you want, I can also give you a one-liner impression (exam-style) or help you phrase the top ddx in a radiology report style.