ke/bv
Date : 00.00.00

Name of the Patient : Abc Xyzalmn / F / 22 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Known C/O TB hilar lymphadenopathy with seizures since 3 months. On eptoin ?? HIV.
C/O weakness of BUE and BLE since February 01, 0000 with lower cranial nerve palsies.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted , proton and T2 Weighted axial images.

5 mm thick FLAIR coronal images.

OBSERVATION :

There are well-circumscribed hyperintense areas in the right lentiform nucleus, subthalamus and the right corona radiata on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images and would represent calcification/paramagnetic substances/methemoglobin. Similar ill-defined hyperintense areas are noted in the left cerebellar hemisphere in the posterior aspect on the T1 Weighted images.

Small, hypointense areas are seen in the thalami, subthalami and cerebral peduncles bilaterally on the proton, T2 Weighted and FLAIR images which are seen to remain hypointense on the T1 Weighted images. These lesions have a peripheral hyperintense rim on the proton, T2 Weighted and FLAIR images with a spectacled appearance.

An ill-defined hyperintense area is seen in the right periatrial deep white matter which is seen to follow CSF signal characteristics on all the pulse sequences. Hypointense areas are seen at the periphery of this lesion on the T1 Weighted images which turns hyperintense on the proton and T2 Weighted and FLAIR images and would represent areas of gliosis. There is slight dilatation of the atrium of the right lateral ventricle and would represent areas of cystic encephalomalacia.





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The left lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable.There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Incidental note is made of bilateral maxillary sinusitis, inflammatory changes in the ethmoidal air cells on the right side and sphenoid sinus.

The cervico-medullary junction is unremarkable. Screening of the upper cervical spinal cord reveals no feature of note.

IMPRESSION :

Altered signal in the right lentiform nucleus, right corona radiata, in the left cerebellar hemisphere, thalami, subthalami and cerebral peduncles bilaterally is most likely due to a
granulomatous infective lesion ike toxoplasmosis.

The possibility of this lesion being tuberculous in origin or a neoplastic process like secondaries is less likely.

A contrast enhanced scan would be useful if clinically indicated.