hs/ke
/49 Date : 00.00.00

Name of the Patient : Abc Xyzl N. lmn / M / 84 yrs.
Referred by : Dr. Abc Xyzarikh / Dr. Abc Xyzmpat.
Examination : M.R.I. of the Brain and Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O gradually progressive loss of vision bilaterally since 1 year.
H/O mild right sided TIAs.
Known diabetic.

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 coronal images.

3 mm thick STIR coronal images through the optic nerves.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

BRAIN :

There are fairly well-defined areas which are near isointense to CSF on all the pulse sequences within the right occipital lobe. Adjacent to these are areas which are hypointense on the T1 Weighted images and which turn hyperintense on the Proton, T2 Weighted and FLAIR images and would represent gliotic changes. This lesion in toto would represent an area of cystic encephalomalacia. There is ex-vacuo dilatation of the occipital horn of the right lateral ventricle.

Hyperintense areas are noted in the left periatrial deep white matter on the T2 Weighted and FLAIR images and would represent areas of ischemia/infarction.

Few areas which are iso to hyperintense to CSF on all the pulse sequences suggestive of lacunar infarcts are seen within the right thalamus and in the white matter adjacent to the left frontal horn. Also seen are prominent Virchow Robin spaces within both cerebral hemispheres.
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There is fullness of the third and both the lateral ventricles. Also seen is prominence of the basal cisternal spaces, cerebellar folia and cerebral cortical sulci bilaterally.

The fourth ventricle is normal. There is no shift of the midline structures.

Inflammatory changes are noted in both the maxillary sinuses.

INTRACRANIAL MRA :

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally 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 :

There is ectasia of the visualized vessels in the neck.

There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. An area of cystic encephalomalacia in the right occipital lobe.

2. Lacunar infarcts within the right thalamus and in the white matter adjacent to the left frontal horn.

3. Area of ischemia/infarction in the left periatrial deep white matter.

4. No significant abnormality is detected within the intracranial /neck MRA on this study.