sb/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzahmed Uslmn / M / 72 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O road accident at 5.30 am on 00.00.00, with loss of consciousness and bleeding from the left ear.
Right temporo-parietal craniotomy with evacuation of subdural hematoma was done on 00.00.00.
For follow-up.

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 and Fast Scan (T2 *) coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is evidence of a right temporo-parietal craniotomy with post-operative changes in the subgaleal soft tissues in that region. There is a sliver of hyperintense signal on all the pulse sequences in the subdural space in the right temporo-parietal region which may represent hemoglobin breakdown products, the sequelae of previous subdural hematoma. A sliver is also seen in the left occipital region.

There is a subdural collection in the right frontal region with a maximum width of about 1.5 cms. This lesion is hyperintense to CSF on all the pulse sequences. Resultant mild indentation on the underlying brain parenchyma is noted. A similar, much smaller lesion is noted in the subdural space in the left frontal region.




Hyperintense areas on the proton, T2 Weighted and FLAIR images are seen to involve the cortical grey matter in the right temporal lobe. This lesion also appears hyperintense on the T1 Weighted images. A smaller, similar area is also noted in the left temporal lobe. These would represent cortical haemorrhagic contusions.

Areas of hyperintensity on the proton, T2 Weighted and FLAIR images are seen within the periventricular white matter bilaterally and these are most likely ischemic in etiology. Foci with similar signal characteristics are noted in the white matter in the frontal lobes bilaterally.

There is mild dilatation of both the lateral and the third ventricles. Also seen is prominence of the cerebral cortical sulci and cerebellar folia bilaterally. The fourth ventricle is normal. There is no shift of the midline structures. The basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.

Suspicious skull vault fracture is noted in the left fronto-parietal region.

Inflammatory changes are noted in the mastoid air cells bilaterally.

IMPRESSION :

1. Post-operative status.

2. A sliver of haemoglobin breakdown products in the subdural space in the right temporo-parietal region and a smaller one in the left occipital region.
..3/.













3. A subdural collection in the right frontal region and a smaller one in the left frontal region.

4. Haemorrhagic cortical contusions involving the cortical grey matter in the temporal lobes, right more than left.

As compared to the previous MRI dated 00.00.00 (scan no.00009), the previously detected right fronto-temporo-parietal hematoma
has significantly decreased in size. A right frontal subdural collection is however noted on the present study. The ventricles have also increased in size on the present study.