ke/sb/rg/nl
Date : 00.00.00
Name of the Patient : Abc XyzRaflmn / M / 30 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
Known C/O TB Meningitis. On AKT since 2-3 days.
C/O tingling in BLE since 6 days.
EXAMINATION :
M.R.I of the lumbo-sacral spine was performed using the following parameters :
5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.
OBSERVATION :
There is a small postero-central disc herniation at the L4-L5 level with anterior indentation of the thecal sac. This disc shows loss of water content.
The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
18.0 mm at L1-L2
18.0 mm at L2-L3
16.0 mm at L3-L4
13.0 mm at L4-L5
14.0 mm at L5-S1.
IMPRESSION :
The MRI features are suggestive of a small postero-central disc herniation at the L4-L5 level.
If a meningeal pathology/arachnoiditis is suspected, a contrast enhanced scan is essential.