hs/bv/rg/nl
/26 Date : 00.00.00

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

CLINICAL PROFILE :

C/O right hemiplegia since 5 days and fever (since 1 day) with ? seizure.

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 and Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is evidence of a large irregularly defined space occupying lesion within the basal ganglia on the left side. This lesion is iso to hypointense to gray matter on all the pulse sequences. Patchy hypointense areas are seen within this lesion on the T1 Weighted images which turn hyperintense on the T2 Weighted images and are suggestive of necrotic areas. After contrast administration, this lesion shows intense enhancement with a whorl like pattern. Also seen are areas of hypointensity on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and FLAIR images adjacent to this lesion and would




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represent perilesional edema. This edema is seen to extend into the left fronto-temporo-parietal lobes, left cerebral peduncle and the pons. There is resultant compression upon the third and the left lateral ventricles with a shift of the midline to the right side. Also seen is effacement of the left perimesencephalic cistern and left Sylvian fissure. There is evidence of left uncal herniation and compression upon the left cerebral peduncle.

A smaller similar lesion with perilesional edema is noted along the gyri in the right frontal lobe.

There is mild dilatation of the right lateral ventricle with periventricular hyperintensities on the proton, T2 Weighted and FLAIR images (CSF ooze).

The fourth ventricle is normal.

IMPRESSION :

The MRI features are suggestive of space occupying lesions in the left basal ganglia and right frontal lobe with mass effect and contrast enhancement as described. This is not specific for a single diagnosis. This most likely represents an infective process like tuberculosis.

This is less likely to represent a neoplastic process like multicentric glioma or metastasis.