ke/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Wlmn / F / 5 yrs.
Referred by : Dr. Abc Xyzarmar.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O fever 9 days back.
C/O seizure 5 days back with drowsiness since then.

EXAMINATION :

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

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

3 mm thick T2 Weighted and FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

After administration of contrast, the following parameters were used :

5 mm thick T1 Weighted axial images with magnetization transfer

3 mm thick T1 Weighted coronal images with magnetization transfer.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an ill-defined, hyperintense area on the proton, T2 Weighted and FLAIR images in the left cerebral peduncle, involving the substantial nigra, with slight extension into the subthalamus superiorly. This lesion is hypointense to normal white matter on the T1 Weighted images. Similar signal is also noted in the right cerebral peduncle as well as the periaqueductal grey matter.

After administration of contrast, there is no enhancement within this lesion. There is no other abnormal area of enhancement within the brain parenchyma or the meninges.
..2/.





Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

The MRI features are suggestive of altered signal in the left cerebral peduncle with slight extension into the subthalamus superiorly, in the right cerebral peduncle as well as the periaqueductal grey matter. These changes are not specific for a single diagnosis. The differential diagnosis would include :

1. Demyelination (acute disseminated encephalomyelitis).

2. Brain-stem encephalitis.

3. ?? ischemia (less likely).