ke/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzal lmn / M / 52 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O acute onset of dysphagia with left sided paresthesias since 00.00.00.
Known hypertensive.

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 hyperintense area in the medulla on the right side posteriorly on the T2 Weighted images which would represent an area of infarction.

Similar areas are seen in the periventricular deep white matter and bilateral corona radiata and centrum semiovale. Lacunar infarcts are noted in the left cerebellar hemisphere, bilateral lentiform nuclei and left thalamus.

Slight prominence of the cerebellar folia is seen.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

Incidental note is made of a right maxillary polyp.





INTRACRANIAL MRA :

There is slight irregularity and narrowing of the internal carotid artery in its cavernous and supraclinoid segments on the right side which could be due to atherosclerosis. Slight irregularity of the M1 segment of the right middle cerebral artery is also noted.

There is hypoplasia of the anterior communicating artery on the right side and of the right vertebral artery.

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

NECK MRA :

The right common carotid artery in its entirety appears smaller in calibre as compared to left. There is concentric narrowing of the right internal and external carotid arteries from the level of the right common carotid bifurcation for approximately 1.0 cm cranially.

The right vertebral artery in the neck is also hypoplastic.

The left common carotid artery and its extracranial branches appears normal. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. Medullary infarct on the right side posteriorly.
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2. Areas of ischemia/infarction in the periventricular deep white matter and bilateral corona radiata and centrum semiovale.

3. Lacunar infarcts in the left cerebellar hemisphere, bilateral lentiform nuclei and left thalamus.

4. Slight irregularity and narrowing of the internal carotid artery in its supraclinoid and cavernous segments on the right side which could be due to atherosclerosis.

5. Hypoplasia of the anterior communicating artery and vertebral artery on the right side.

6. Concentric narrowing of the right internal and external carotid arteries from the level of the right common carotid bifurcation for approximately 1.0 cm cranially.