sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyznt Gaolmn / M / 4 yrs.
Referred by : Dr. Abc Xyznshah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

Known C/O TBM with hydrocephalus and right sided hemiparesis since 0000. H/O VP Shunt done 2 years ago.
C/O seizures 2 years back.

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 volume loss of the left cerebral hemisphere. There is an ill-defined, hyperintense signal on the T2 Weighted images in the left fronto-temporo-parietal deep white matter. This lesion appears hypointense on the T1 Weighted images and represents an area of cystic encephalomalacia, most likely the sequelae of a previous ischemic lesion. Resultant pull of the midline to the left is noted. The left cerebral peduncle appears hypoplastic. Atrophy of the posterior body and splenium of the corpus callosum is noted.

A shunt tube is seen to traverse the left temporal lobe with its tip probably in the region of the splenium of the corpus callosum.

A focal hypointense lesion on the T2 Weighted images is noted in the left deep temporal lobe which may represent a calcified granuloma.





Both the lateral and third ventricles are collapsed due to shunt tube. The fourth ventricle is normal. The basal cisternal spaces are unremarkable.

INTRACRANIAL MRA :

The left middle cerebral artery appears as a very thin strand just distal to its origin. The Sylvian branches on the left are not identified.

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

NECK MRA :

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. Post-shunt status.

2. Volume loss of the left cerebral hemisphere with lateral signal in the left fronto-temporo- parietal deep white matter most likely is the sequelae of a previous vascular insult.

3. Focal altered signal in the left deep temporal lobe may represent a calcified granuloma.

4. The left middle cerebral artery appears as a thin strand just distal to its origin which may be the sequelae of tuberculous vasculitis, in the given clinical setting.

No previous scans were available for review.