sb/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzA.H. lmn / M / 28 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O vehicular accident on 00.00.00 at 3.00 pm with head trauma and altered sensorium.
H/O seizure and vomiting +.

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.

OBSERVATION :

There is seen a communited, depressed fracture of the skull vault in the left posterior parietal and temporo-parietal region.

There is an ill-defined, hyperintense signal on the proton, T2 Weighted and FLAIR images in the left posterior temporo-parietal cortex, right inferior temporal region and in the right inferior frontal region. These lesions appear hypointense to normal grey matter on the T1 Weighted images and most likely represent cortical contusions, in the given clinical setting. A hypointense focus on the T2 Weighted images within the lesion in the right inferior frontal region may represent a haemorrhagic focus. A suspicious cortical contusion is noted in the right high parietal region.






There is seen an extracerebral (most likely extradural) collection in the left fronto-temporo-parietal region with a maximum width of about 1.1 cms. This lesion is isointense to the normal white matter on the T1 Weighted images and appears heterogeneously hyperintense on the T2 Weighted images and represents an extradural hematoma. Resultant slight effacement of the sulcal spaces is noted.

Soft tissue in the left frontal sinus may represent hemorrhage.

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.

Subgaleal hematoma is noted over the left hemicranium and in the high parietal region on the right.

Incidentally noted is a cavum septum pellucidum.

IMPRESSION :

1. A communited, depressed fracture of the skull vault in the left posterior parietal and temporo-parietal region.

2. Altered signal in the left posterior temporo-parietal cortex, right inferior temporal region and in the right inferior frontal region represents cortical contusions, in the given clinical setting.

3. An extracerebral (most likely extradural) hematoma in the left fronto-temporo-parietal region with a maximum width of about 1.1 cms.

4. Subgaleal hematoma over the left hemicranium and in the high parietal region on the right.