ke/hs/nl/nl
/902 Date : 00.00.00

Name of the Patient : Abc Xyzar Shlmn / M / 31 yrs.
Referred by : Dr. Abc Xyzh.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided hemiparesis since 2 days.
HIV +ve.

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.

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

OBSERVATION :

BRAIN :

There is a hypointense area on the T1 Weighted images in the right corona radiata. This is seen to turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images.

Hypointense areas are noted on the T1 Weighted images in the right frontal deep white matter, right lentiform nucleus and the right insular cortex. These are seen to follow CSF intensity characteristics on all the pulse sequences and would represent lacunar infarcts. Perilesional gliosis is also seen (better appreciated on the FLAIR images).

There is slight fullness of the both the lateral ventricles.



The third and fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

Incidental note is made of left maxillary polyp and mucosal thickening in the ethmoidal air cells.

INTRACRANIAL MRA :

There is narrowing of the M1 segment of the right middle cerebral artery as compared to the left. The distal portion is grossly narrowed with paucity of the vessels in the region of the right Sylvian fissure.

The right anterior communicating and the right vertebral arteries are hypoplastic.

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior 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 is hypoplastic.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
..3/.














- 3 - Scan-00000/902


IMPRESSION :

1. Altered signal in the right corona radiata is not specific for a single etiology. The possibilities to be considered are :

a. Infarct.
b. Granuloma - less likely.

2. Lacunar infarcts in the right frontal deep white matter, right lentiform nucleus and the right insular cortex.

3. Narrowing of the M1 segment of the right middle cerebral artery as compared to the left. The distal segment is grossly narrowed with paucity of the vessels in the region of the right Sylvian fissure (? vasculitis).