hs/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzram Almn / M / 9 yrs.
Referred by : Dr. Abc Xyzgrawal.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O seizures since 4 years.
H/O right hemipareses on 00.00.00.

EXAMINATION :

M.R.I. of the brain was performed using the following parameters:

5 mm thick T1 Weighted 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.

FEW IMAGES (NECK MRA) SHOW PATIENT MOTION.

OBSERVATION :

BRAIN :

There is a diffuse area of hyperintensity on the T2 Weighted and FLAIR images within the left cerebral hemisphere with slight effacement of the cerebral cortical sulci.

Areas of similar signal characteristics are seen within the midbrain (red nuclei), pons and deep white matter in the fronto-parietal lobes bilaterally.

There is fullness of the fourth, third and both the lateral ventricles. Also seen is prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

There is no shift of the midline structures.
..2/.








INTRACRANIAL MRA :

There is apparent narrowing of the posterior aspect of the left internal carotid artery (artifactual).

The petrous, cavernous and supraclinoid segments of the right internal carotid artery show normal signal and calibre. The visualized anterior cerebral, 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 :

The MRA features are suggestive of :

1. Areas of altered signal within the left cerebral hemisphere, midbrain (red nuclei), pons and deep white matter in the fronto-parietal lobes bilaterally is not specific for a single etiology. The differential diagnosis would include,

a. Areas of ischemia/infarction (? vasculitis).

b. Demyelination.

c. Metabolic disorders like motachondrial disorders (eg. MELAS)

2. No significant abnormality is detected on the intracranial and neck MRA on this study.