sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzVidlmn / M / 70 yrs.
Referred by : Dr. Abc Xyz.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O momentary giddiness with perspiration and weakness - 1st episode 9 years back and 2nd episode on 00.00.00.

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.

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

OBSERVATION :

BRAIN :

A lacunar infarct (iso to hyperintense to CSF) is noted in the left corona radiata.

Ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images are noted in the posterior parietal periventricular white matter bilaterally, right temporo-parietal white matter and in the left fronto-parietal deep white matter and thalamus. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images and most likely represent ischemic changes.

There is mild dilatation of the left lateral ventricle. The right lateral, third and the fourth ventricles are normal.
..2/.






The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

The right vertebral artery is hypoplastic. Tortuousity of the vertebro-basilar system is noted.

There is significant stenosis of the M1 segment of the left middle cerebral artery, in its mid-segment. Slight attenuation of the Sylvian branches of the left middle cerebral artery is noted. The stenosis is identified in two places.

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, right middle cerebral, basilar, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The right vertebral artery in the neck appears hypoplastic.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. A lacunar infarct in the left corona radiata.

2. Altered signal in the posterior parietal periventricular white matter bilaterally, right temporo-parietal white matter and in the left fronto-parietal deep white matter and thalamus most likely represent ischemic changes.

3. Significant stenosis of the M1 segment of the left middle cerebral artery, in its mid-segment may be atherosclerotic in etiology.