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Date : 00.00.00

Name of the Patient : Abc XyzH. lmn / F / 60 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right hemiparesis with slurred speech since 10 days.
Known hypertensive. On Rx.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial and 5 mm thick FLAIR coronal images.

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

OBSERVATION :

There is a well-marginated, hyperintense lesion on the T2 Weighted images in the left high fronto-parietal region (scans 102.15). This lesion appears hypointense to normal white matter on the T1 Weighted images and may represent a recent ischemic lesion.

CSF signal characteristics lesions on all pulse sequences are noted in the right occipital lobe, right cerebellar hemisphere and in the head of right caudate nucleus and right anterior capsular region. These represent areas of cystic encephalomalacia, most likely the sequelae of previous vascular insult. Evidence of extracellular methaemoglobin (late subacute haemorrhage) is noted in the head of right caudate nucleus and right anterior capsular region.

There are ill-defined hyperintense areas on the T2 Weighted and FLAIR images in the periventricular white matter bilaterally and in the thalami, lentiform nuclei and centrum semiovale bilaterally. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images and most likely represent ischemic changes.
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There is mild dilatation of both the lateral, third and the fourth ventricles. The basal cisternal spaces are unremarkable. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally. There is no shift of the midline structures.

INTRACRANIAL MRA :

The right vertebral artery appears hypoplastic. The right posterior cerebral artery appears as a continuation of the right posterior communicating artery.

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

There is slight concentric narrowing of the proximal left internal carotid artery, approximately 1.9 cms distal to the left common carotid bifurcation. The common corotid arteries and their bifurcations bilaterally are unremarkable.

The right vertebral artery in the neck also appears hypoplastic.

IMPRESSION :

1. Altered signal in the left high fronto-parietal region may represent a recent ischemic lesion.

2. Altered signal in the right occipital lobe, right cerebellar hemisphere and in the head of right caudate nucleus and right anterior capsular region represent areas of cystic encephalomalacia, most likely the sequelae of previous vascular insult.
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3. Evidence of extracellular methaemoglobin (late subacute haemorrhage) in the head of right caudate nucleus and right anterior capsular region.

4. Altered signal in the periventricular white matter
bilaterally and in the thalami, lentiform nuclei and centrum semiovale bilaterally most likely represent ischemic changes.

5. Slight concentric narrowing of the proximal left internal carotid artery, approximately 1.9 cms distal to the left common carotid bifurcation.