Date : 00.00.00

Name of the Patient : Abc Xylmn / F / 37 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O right side hemiparesis with aphasia on 00.00.00.
Past H/O brain stem demyelinating disorder in November 0000.

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.

OBSERVATION :

There are hyperintense areas on the proton, T2 Weighted and FLAIR images in the midbrain on the right side (scan 102/9), left cerebral peduncle, left subthalamus and both parathird ventricular regions. Another similar area is noted in the medulla on the right side (scan 102.4). These are hypointense to white matter on the T1 Weighted images. There is slight fullness of the fourth ventricle with mild prominence of the cerebellar folia bilaterally.

Both the lateral and third 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.

Incidental note is made of bilateral maxillary sinusitis and inflammatory changes in the right mastoid air cells.



Hyperintense signal is identified on all the pulse sequences in the right transverse sinus extending into the right jugular vein replacing the normal flow void signal within the sinus. This is suggestive of thrombosis/slow flow (probably the sequelae of right mastoiditis). The other sinuses show normal flow void signal.

IMPRESSION :

1. Altered signal in the midbrain and medulla on the right side, left cerebral peduncle and parathird ventricular region bilaterally is not specific for a single diagnosis.

In view of the past H/O demyelinating disorder, these most likely represent demyelinating plaques.

However similar MRI appearances may be seen with ischemia/infarction.

2. Right transverse sinus thrombosis.

No previous investigations were available for comparison.