hs/sb/nl.
/13 Date : 00.00.00

Name of the Patient : Abc Xyzhchand Chhlmn / M / 64 yrs.
Referred by : Dr. Abc Xyzandel / Dr. Abc Xyzra.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right sided hemiparesis with loss of consciousness for 36 hours, 10 days back.
H/O right sided hemiparesis in April 0000 from which patient recovered.

EXAMINATION :

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

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

OBSERVATION :

There is evidence of an area which is near isointense to CSF on the T1 Weighted and T2 Weighted images within the head of the left caudate nucleus. An area of hypointensity on the T2 Weighted images is seen adjacent to this lesion and would most likely represent hemosiderin. There is ex-vacuo dilatation of the left frontal horn.

Hyperintense areas on the T2 Weighted images are seen in the periatrial white matter bilaterally and are most likely ischemic in etiology.

There is fullness of the third and both the lateral ventricles. There is mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Scan-00001/13



INTRACRANIAL & NECK MRA :

The right vertebral artery is not visualized from its origin (distal portion prior to bifurcation seen, ? retrograde flow).

There is slight vessel wall irregularity and concentric narrowing of the cavernous segment of the right internal carotid artery.

There is vessel wall irregularity and attenuation of the flow signal within the proximal segment of the left middle cerebral artery, the left posterior cerebral artery and the basilar artery.

The A1 segment of the right anterior cerebral artery appears to be hypoplastic.

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

Concentric narrowing with flow signal attenuation is noted in the proximal 1.5 cms segment of the right internal carotid artery, just distal to the right common carotid bifurcation. The left common carotid artery and its bifurcation and the left vertebral artery are unremarkable.

IMPRESSION :

The MRA features are suggestive of :

1. An area of encephalomalacia within the head of the left caudate nucleus.
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- 3 - Scan-00001/13




2. Non-visualization of the right vertebral artery from its origin (distal portion prior to bifurcation seen, ? retrograde flow).

3. Slight vessel wall irregularity and concentric narrowing of the cavernous segment of the right internal carotid artery.

4. Vessel wall irregularity and attenuation of the flow signal within the proximal segment of the middle cerebral artery and the left posterior cerebral artery.

5. Stenosis of the proximal segment of the right internal carotid artery just distal to the right common carotid bifurcation.