ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzik Nlmn / M / 1 1/2 yrs.
Referred by : Dr. Abc Xyzwant.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O TB Meningitis with hydrocephalus.
A V.P.Shunt was placed 15 days ago.

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 T2 Weighted and FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

The pons and the lower portion of the medulla appear swollen. A lesion which is hypointense to the white matter on the T1 Weighted images is seen in the pons on the right side anteriorly and which is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images. Hyperintense areas are also noted extending into the right middle cerebellar peduncle and the lower portion of the midbrain. Hypointense areas on the T2 Weighted and Proton images are seen within the lesion in the pons with a probable exophytic component. The fourth ventricle is slightly reduced in its antero-posterior dimension.

An intermediate signal intensity is seen within the aqueduct on the T1 Weighted images which is heterogeneously hyperintense on the proton and T2 Weighted images.



- 2 - Scan-00006


There is severe dilatation of the third and both the lateral ventricles with periventricular hypointensities (CSF ooze). There is resultant thinning of the corpus callosum. A ventriculostomy tube is seen to traverse from the right posterior parietal region superior to the body of the right lateral ventricle and extending anteriorly into the frontal parafalcine region.

A hypointense area is seen in the tip of the frontal horn of the right lateral ventricle (scans 103.10) on the T1 Weighted images and which is seen to bloom on the proton and T2 Weighted images and may represent air.

There is mild prominence of the cerebellar folia bilaterally.

IMPRESSION :

1. Post-shunt status with a ventriculostomy tube seen to traverse from the right posterior parietal region superior to the body of the right lateral ventricle with the tip in the right frontal parafalcine region.

2. Altered signal in the pons is not specific for a single etiology ? granulomas (? neoplastic process like an
astrocytoma)

3. ? debris ?? haemorrhage ? exudates in the aqueduct with severe dilatation of both the lateral and the third ventricles.

A contrast enhanced scan would be worthwhile.