sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzKanlmn / M / 52 yrs.
Referred by : Dr. Abc Xyzhta.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O blurring of vision on the right side for 1 day, 5 days back.
C/O headaches since 5 days.
Known hypertensive.

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.

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

OBSERVATION :

BRAIN :

There are ill-defined, hypointense areas on the T1 Weighted images in the cerebellar hemispheres bilaterally, more pronounced on the right side, pons on the right and in the left temporo-parieto-occipital region. These lesions appear hyperintense on the proton, T2 Weighted and FLAIR images and most likely represent recent ischemic lesions. Resultant effacement of the cerebellar folia, in the right cerebellar hemisphere and cerebral cortical sulci in the left temporo-parieto-occipital region is noted with minimal indentation on the posterior fourth ventricle.



Lacunar infarcts (isointense to hyperintense to CSF) are noted in the lentiform nuclei and thalami bilaterally, bilateral external capsular regions, right corona radiata and in the right centrum semiovale.

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the periventricular white matter bilaterally, bilateral centrum semiovale and in the subcortical white matter in the frontal regions bilaterally. These lesions also appear hypointense on the T1 Weighted images.

There is mild dilatation of both the lateral and third ventricles. There is slight prominence of the cerebral cortical sulci bilaterally.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

The A1 segment of the right anterior cerebral artery and the right vertebral artery appear hypoplastic.

The right posterior cerebral artery is visualized only its proximal segments.

Narrowing of the distal 0.5 cms of the left vertebral artery is noted. Slight irregularity of the mid segment of the left middle cerebral artery is also noted.

Slight tortuousity of the intracranial segments of the internal carotid arteries is noted, bilaterally.

No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The right vertebral artery in the neck is also hypoplastic.
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There is slight flattening of the bulb of the right common carotid artery. No obvious stenosis of the origins of the right internal and external carotid arteries is however noted.

The left common carotid artery and its bifurcation are unremarkable.

IMPRESSION :

1. Altered signal in the cerebellar hemispheres bilaterally, more pronounced on the right side, pons on the right and in the left temporo-parieto-occipital region most likely represent recent ischemic lesions.

2. Lacunar infarcts in the lentiform nuclei and thalami bilaterally, bilateral external capsular regions, right corona radiata and in the right centrum semiovale.

3. Altered signal in the periventricular white matter bilaterally, bilateral centrum semiovale and in the subcortical white matter in the frontal regions bilaterally represent ischemic changes.

4. Hypoplasia of the A1 segment of the right anterior cerebral artery and the right vertebral artery.

5. The right posterior cerebral artery is visualized only in its proximal segments.

6. Narrowing of the distal 0.5 cms of the left vertebral artery and slight irregularity of the mid segment of the left middle cerebral artery may be due to atherosclerotic changes.

7. Slight flattening of the bulb of the right common carotid artery.