sb/ke/nl/eg.
/602 Date : 00.00.00

Name of the Patient : Abc Xyzhurlmn / M / 52 yrs.
Referred by : Dr. Abc Xyzh.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A and
Intracranial MRV.

CLINICAL PROFILE :

C/O frontal headaches since 2 days.
H/O sagittal sinus thrombosis 2 years back.

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.

MRV was performed using a 2D TOF technique.

OBSERVATION :

BRAIN :

There is seen a well-marginated, CSF signal intensity lesion on all the pulse sequences in the left inferior temporal region, which represents an area of cystic encephalomalacia. Resultant mild dilatation of the temporal horn of the left lateral ventricle is noted. Perilesional white matter hyperintense signal on the T2 Weighted and FLAIR images would represent gliotic changes.

A small bright focus, best appreciated on the FLAIR images is noted in the subcortical white matter in the right frontal region, which would represent an ischemic focus.



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

Inflammatory changes are noted in the ethmoidal air cells bilaterally.

INTRACRANIAL MRA :

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

NECK MRA :

There is a probable atherosclerotic plaque along the postero-lateral wall of the proximal left internal carotid artery, just at the common carotid bifurcation.

The right common carotid artery and its bifurcation and the vertebral arteries are unremarkable.

INTRACRANIAL MRV :

There is slight irregularity of the superior sagittal sinus which is not visualized in its entirety. Multiple collateral channels are noted. The left transverse sinus is probably hypoplastic (?? fibrosed). The internal cerebral veins, vein of Galen and the straight sinus are unremarkable. The right transverse sinus appears slightly attenuated.
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IMPRESSION :

1. An area of cystic encephalomalacia in the left inferior temporal region.

2. An ischemic focus in the right frontal subcortical white matter.

3. Changes in the superior sagittal sinus most likely is the sequelae of previous sagittal sinus thrombosis and subsequently recanalization.

4. A probable plaque along the postero-lateral wall of the proximal left internal carotid artery.