sb/ke/nl/rg.
Date : 00.00.00 Name of the Patient : Abc Xyzao Plmn / M / 57 yrs.Referred by : Dr. Abc Xyzrani.Examination : M.R.I. of the Brain.
CLINICAL PROFILE : H/O craniotomy for left high parietal parafalcine SOL. Partial excision of SOL done 00.00.00. Detected to have glioblastoma multiforme. Received radiotherapy from 00.00.00 to 00.00.00. Follow-up MRI on 00.00.00 revealed a communicating hydrocephalus with periventricular CSF ooze. VP shunt done on 00.00.00.
Now admitted with altered sensorium with right hemiplegia.

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.5 mm thick T1 Weighted sagittal images.
SOME IMAGES SHOW PATIENT MOTION.
OBSERVATION :There is evidence of a left high parietal craniectomy.
There is seen a cystic lesion in the left posterior parietal and left deep parietal region, which follows CSF signal on all pulse sequences. This lesion is just deep to the craniectomy site and extends nearly upto the left lateral ventricular wall and may represent the site of previous surgery. This lesion shows focal hyperintense signal on all the pulse sequences which may represent extracellular methemoglobin.
Scan-00003

There is diffuse, hyperintense signal on the proton, T2 Weighted and FLAIR images in the white matter in the left fronto-temporo-parietal region and in the left thalamus, subthalamic region and in the left cerebral peduncle. This signal appears hypointense on the T1 Weighted images. Resultant sulcal space effacement is noted with compression of the left lateral and the third ventricles, effacement of the left ambient cistern and mild shift of the midline structures to the right. No focal lesion is identified within the above described diffuse signal change. Involvement of the body of the corpus callosum is noted.

There is mild dilatation of the right lateral and fourth ventricles. Periventricular white matter hyperintense signal
on the T2 Weighted images may represent periventricular CSF ooze. The tip of the shunt tube is noted in the body of the right lateral ventricle.
No obvious vascular anomaly is identified on this study.IMPRESSION :
1. Post-operative, post-shunt status.

2. An area of cystic encephalomalacia in the left posterior parietal and left deep parietal region which may be the sequelae of previous surgery.

3. Diffuse altered signal in the left fronto-temporo-parietal white matter and in the left thalamus, subthalamic region and left cerebral peduncle as described, is not specific for a single etiology. This may either represent post-radiation changes or diffuse infiltrative tumor tissue. Involvement of the body of the corpus callosum is noted.
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- 3 - Scan-00003




4. Mild dilatation of the right lateral ventricle with periventricular hyperintense signal may represent periventricular CSF ooze - ? malfunctioning shunt. The tip of the shunt tube is noted in the body of the right lateral ventricle.

5. Dilated fourth ventricle.

A contrast enhanced scan would be worthwhile.

As compared to the previous MRI (study no:00000) dated 00.00.00, the patient is now status post-shunt. Right lateral and fourth ventricle still appear dilated with periventricular CSF ooze. The left lateral and third ventricles are compressed and effaced by the altered signal in the white matter in the left temporo-parietal region. This signal change may either represent post-radiation changes or may represent infiltrative tumor tissue. Body of the corpus callosum is now involved.