hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyzra D. Klmn / M / 26 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O neck pain (nape) with numbness of the tongue on the left side with difficulty in speaking and swallowing.
H/O fever.
O/E lower cranial nerve (X, XI and XII) palsy.

EXAMINATION :

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

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

4 mm thick GRASS coronal images through the region of interest.

5 mm thick GRASS and T1 Weighted axial images. .

OBSERVATION :

Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted and GRASS images are seen to involve the left lateral mass of the atlas and the left occipital condyle with involvement of the left atlanto-occipital joint. There is extension into the left paravertebral soft tissues and left anterior epidural space with indentation upon the cord and cervico-medullary junction at this level.

Enlarged lymph nodes are noted in the cervical region. Inflammatory changes are seen within the paranasal sinuses.

There is no focal area of altered signal intensity within the brain parenchyma.

Both the 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.
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IMPRESSION :

The MRI features are suggestive of a pathologic process involving the left atlanto-occipital joint and enlarged lymph nodes in the cervical region. This is most likely the result of an infective process like tuberculosis.

The possibility of this being a neoplastic process is less likely.