hs/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyz.Nasir Shlmn / M / 5 yrs.
Referred by : Dr. Abc Xyzwant.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O TBM with hydrocephalus. VP shunt done 1 month back.
C/O rigidity of BUE and BLE since 1 month.

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.

OBSERVATION :

There is evidence of a ventriculostomy tube coursing through the right parietal lobe with the tip lying within the frontal horn of the left lateral ventricle.

Concavo-convex shaped lesions are seen to overlie both the cerebral hemispheres. These lesions are hyperintense to CSF on all the pulse sequences. Also seen are areas of hyperintensity on all the pulse sequences within these lesions. These lesions would represent extracerebral (subdural) collections of fluid and blood. There is resultant indentation upon the underlying brain parenchyma. Multiple hypointense areas with susceptibility artifacts and fluid level on all the pulse sequences are seen within the extracerebral collection on the right side and these would represent air.

Multiple hypointense lesions on the proton, T2 Weighted and FLAIR images are seen within both the cerebellar hemispheres and these may represent granulomas. A hyperintense lesion on the proton and T2 Weighted images is seen in the region of the left peripontine cistern with resultant indentation upon the pons.



There is evidence of a lesion which is hypointense with a hyperintense rim on the T1 Weighted images and predominantly hyperintense on the T2 Weighted images within the left frontal lobe and this would represent a subacute hematoma. There is mild perilesional edema with indentation upon the frontal horn of the left lateral ventricle.

An area of hypointensity on the T1 Weighted images which turns hyperintense on the proton, T2 Weighted and FLAIR images is seen within the left lentiform nucleus and head of the left caudate nucleus. This is most likely ischemic in etiology.

Lacunar infarcts (iso to hyperintense to CSF) are seen within the region of the anterior limb and genu of the right internal capsule and the right lentiform nucleus.

The frontal horn, body and atrium of the right lateral ventricle are seen to be compressed as a result of the right extracerebral collection of fluid/blood. There is a mild shift of the midline structures to the left side. There is mild fullness of the left lateral and fourth ventricles and the temporal horn of the right lateral ventricle.

IMPRESSION :

1. Post-shunt status.

2. Bilateral (right more than left) extracerebral (subdural) collection of fluid/blood overlying both cerebral hemispheres.






- 3 - Scan-00007


3. Space-occupying lesions within both the cerebellar hemispheres and in the region of the left peripontine cistern indenting upon the pons may represent tuberculomas in the given clinical setting of tuberculous meningitis.

4. Subacute hematoma in the left frontal lobe.

5. Areas of altered signal within the left lentiform nucleus and head of the left caudate nucleus most likely is ischemic in etiology.

6. Lacunar infarcts within the region of the anterior limb and genu of the right internal capsule and the right lentiform nucleus.

7. Air within the extracerebral collection on the right side.