sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyza Kalmn / F / 60 yrs.
Referred by : Dr. Abc Xyzm.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O loss of consciousness for 2 hours on 00.00.00 and similar complaints on 00.00.00 for a day.
C/O altered sensorium 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.
5 mm thick 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 and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is seen a conglomeration of multiple rim enhancing lesions in the right medial temporal lobe. This conglomeration measures approximately 1.8 x 1.2 x 1.2 cms. This lesion appears iso to hypointense to normal white matter on the T1 Weighted images and appears hypointense on the T2 Weighted images. There is mild perilesional edema.

After contrast administration, there are multiple, very small, subcentimeter, rim enhancing lesions at the tip of the left cerebellar tonsil and in the left temporal cortex near the left Sylvian fissure. These lesions are not well identified on the unenhanced scan.

A CSF signal intensity lesion on all the pulse sequences is noted in the head of the left caudate nucleus and left anterior capsular region which most likely represents an old infarct.
..2/.




There are ill-defined, non-enhancing hyperintense lesions on the proton, T2 Weighted and FLAIR images in the pons, subcortical white matter in the left posterior parietal region, posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale. These most likely represent ischemic changes.

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

Incidentally noted is intermediate signal within the left sigmoid sinus and proximal left internal jugular vein which may represent slow flow.

An empty sella is also noted.

IMPRESSION :

1. An approximately 1.8 x 1.2 x 1.2 cms sized conglomeration of multiple rim enhancing lesions in the right medial temporal region follows the signal characteristics of tuberculomas. Smaller, subcentimeter lesions are noted in the left cerebellar tonsil and left temporal cortex.

The possibility of these lesions representing neoplasm seems less likely.

2. Old infarcts in the head of the left caudate nucleus and left anterior capsular region.

3. Areas of altered signal in the pons, subcortical white matter in the left posterior parietal region, posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale most likely represent ischemic changes.