This is a non-contrast CT scan of the brain. 1. Most likely diagnosis and why? Diagnosis: Acute Intracerebral Hemorrhage (ICH) in the basal ganglia region (likely putamen). Why? Hyperdense (bright white) area within the deep brain structures consistent with acute blood. Surrounding hypodense (dark) area, suggesting edema. Mass effect with midline shift and compression of the lateral ventricle. Classical location for hypertensive hemorrhage. 2. Next best diagnostic step? Immediate step: Neurocritical stabilization (airway, blood pressure control, reversal of anticoagulation if applicable). Diagnostic step: CT angiography of the head to rule out underlying vascular lesions (aneurysm, AVM). Consider MRI brain later if structural cause (tumor, cavernoma) suspected once stable. 3. Key differential or confirmatory test? Differential diagnoses: Hemorrhagic transformation of ischemic stroke. Hemorrhage into a tumor (glioblastoma, metastasis). Vascular malformation (AVM, aneurysm). Confirmatory tests: CTA/MRA: to exclude vascular malformations. MRI with contrast: to detect underlying neoplasm or secondary cause. 4. Possible treatment or management? Acute Management: Admit to ICU/stroke unit. Maintain airway, oxygenation, BP control (systolic <140 mmHg recommended). Reverse anticoagulation (if on warfarin, DOACs). Manage intracranial pressure (head elevation, hyperosmolar therapy if needed). Surgical Options: Neurosurgical consultation: evacuation of hematoma or decompressive craniectomy if large mass effect, deteriorating patient, or cerebellar ICH. Long-term: Control of hypertension, diabetes, antithrombotic management. Rehabilitation (physiotherapy, occupational therapy, speech therapy). ✅ Summary: This CT brain shows a large intracerebral hemorrhage in the left basal ganglia region with surrounding edema and mass effect, most consistent with hypertensive bleed. Next steps include CTA head to exclude vascular malformation, ICU-level supportive care, and neurosurgical evaluation for possible evacuation. Would you like me to also comment on the ICH score (severity/prognosis scale) based on this CT?