/72 Date : 00.00.00

Name of the Patient : Abc Xyzimohalmn / M / 55 yrs.
Referred by : Dr. Abc Xyznghal.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right sided hemiplegia since 1 year.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There is a well marginated, hypointense lesion on the T1 Weighted images in the left fronto-temporo-parietal cortex and subcortical white matter. This lesion follows CSF signal on all the pulse sequences and represents an area of cystic encephalomalacia, most likely the sequelae of a previous vascular insult. Perilesional, ill-defined, hyperintense signal on the T2 Weighted images may suggest gliotic changes. There is resultant dilatation of the left lateral ventricle as compared to the right. Atrophy of the left cerebral peduncle is also noted with a subtle hyperintense signal within it and in the anterior pons to the left (Wallerian degeneration).

Ill-defined, hyperintense signal on the T2 Weighted images in the subcortical white matter in the right posterior parietal region may also represent ischemic lesions.

There is mild fullness of the right lateral ventricle. The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Scan-00000


There is seen a hyperintense signal on the T2 Weighted images within the lumen of the cavernous and supraclinoid segment of the left internal carotid artery in place of the normal flow-void signal.

INTRACRANIAL MRA :

The left vertebral artery is most likely hypoplastic and is not well identified intracranially.

There is non-visualization of the intracranial segment of the left internal carotid artery. Faint visualization of the left anterior, middle and posterior cerebral arteries is noted.

The petrous, cavernous and supraclinoid segments of the right internal carotid artery show normal signal and calibre. The visualized right anterior cerebral, right middle cerebral, basilar, right vertebral and right posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The left vertebral artery is hypoplastic.

The left common carotid artery appears unremarkable. There is flattening of the left carotid bulb with slight concentric narrowing of the origin of the left external carotid artery at the carotid bifurcation. Similar changes are noted at the origin of the left internal carotid artery which is not visualized after about 1.5 cms distal to the common carotid bifurcation.

The right common carotid artery and its bifurcation and the right vertebral artery are unremarkable.
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IMPRESSION :

1. Altered signal in the left fronto-temporo-parietal region represents an area of cystic encephalomalacia, most likely the sequelae of a previous vascular insult.

2. Altered signal in the subcortical white matter in the right posterior parietal region most likely represents ischemic changes.

3. Complete obstruction of the left internal carotid artery about 1.5 cms distal to the common carotid bifurcation.

4. Concentric narrowing of the left internal and external carotid arteries.

5. Hypoplastic left vertebral artery.