sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyza A. Qurlmn / F / 36 yrs.
Referred by : Dr. Abc Xyzhta.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches with altered behaviour for 2-3 hours on 00.00.00.
C/O similar complaints 1 year ago.
H/O HIV with toxoplasmosis in brain since July 0000. On treatment.

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.

OBSERVATION :

There is seen a well marginated, subcentimeter, iso to slightly hyperintense lesion on the T1 Weighted images in the subcortical white matter in the left high parietal region. This lesion shows a hyperintense signal, centrally, with a peripheral hypointense rim on the proton, T2 Weighted and FLAIR images. There is perilesional edema with slight sulcal space effacement in that region.

A fairly large, approximately 2.8 x 2.0 cms sized lesion following similar signal characteristics is noted in the right inferior frontal and frontal region. There is significant perilesional edema with sulcal space effacement and mild indentation on the frontal horn of the right lateral ventricle.

Perilesional edema is also noted around the small lesions in the right high parietal region.

There is an ill-defined, mixed signal intensity lesion (hypointense and hyperintense signal on the T1 Weighted, proton and T2 Weighted images) on all the pulse sequences in the right posterior temporal cortex and subcortical white matter. Focal dilatation of the temporal horn of the right lateral ventricle is noted.
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There are focal, hypointense lesions on the T1 Weighted images in the right cerebellar hemisphere, cerebral peduncles bilaterally, bilateral thalami and lentiform nuclei and in the subcortical white matter in the fronto-parietal regions bilaterally. These lesions appear hyperintense on the proton and T2 Weighted images while some of them remain hypointense on the FLAIR images. There is no significant perilesional edema around these lesions.

There is mild dilatation of both the lateral, third and fourth ventricles. There is slight prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally.

There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

1. Subcentimeter lesion with perilesional edema in the high parietal regions bilaterally may represent recurrent/fresh granulomas.

2. An approximately 2.8 x 2.0 cms sized granuloma in the right inferior frontal and frontal region, with perilesional edema.

3. Altered signal intensity lesion in the right posterior temporal lobe represents an area of encephalomalacia with haemorrhagic/paramagnetic substance deposition, probably the sequelae of a previous vascular insult.

4. Multiple focal lesions in the right cerebellar hemisphere, cerebral peduncles bilaterally, bilateral thalami and lentiform nuclei and in the subcortical white matter in the fronto-parietal regions bilaterally as described may represent resolved granulomas/lacunes .

5. Mild cerebral cortical and cerebellar atrophy with ventricular fullness.

As compared to the previous MRI dated 00.00.00, there are recurrent/fresh lesions in the posterior parietal regions bilaterally and in the right inferior frontal and frontal region. The rest of the lesions are largely unchanged.