hs/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz M. Rilmn / F / 20 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : M.R.I. of the Brain & Intracranial
MR Venogram.

CLINICAL PROFILE :

C/O left sided hemiplegia with loss of consciousness since 3 days.

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 and Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.
MR Venogram was obtained using 2D TOF sequence.

OBSERVATION :

Brain :

There is evidence of an irregularly defined area of hypointensity on the T1 Weighted images which turns hyperintense on the proton, T2 Weighted and FLAIR images within the right fronto-parietal lobes. There is involvement of the cortical grey matter as well as the underlying deep white matter. A smaller area with similar signal characteristics is seen in the left high frontal lobe. There is effacement of the cerebral cortical sulci adjacent to these lesions.

Areas of hyperintensity on the T1 Weighted images are noted within the lesion in the right fronto-parietal lobes. Some of these turn hyperintense on the T2 Weighted images whereas a few remain hypointense and would represent subacute blood. This lesion is seen to compress upon the third and right lateral ventricles with a shift of the midline structures to the left. Also seen is right uncal herniation, transtentorial herniation and compression upon the midbrain on the right side.
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The normal flow void signal is not evidence within the anterior aspect of the superior sagittal sinus. The fourth ventricle is normal.

MR Venogram :

The normal flow signal is not seen within the anterior aspect of the superior sagittal sinus and this may suggest a thrombosis.

A streak of flow is seen within the left transverse sinus (? hypoplastic sinus ? thrombosed with partial recanalization).

On the MRV the rest of the visualized dural and deep venous sinuses show normal flow characteristics.

IMPRESSION :

The MRI/MRV features are suggestive of :

1. A large haemorrhagic infarct (most likely venous) within the right fronto-parietal lobes with mass effect and right uncal herniation and transtentorial herniation as described.

2. A smaller infarct (most likely venous) in the left high frontal lobe.

3. Thrombosis of the anterior aspect of the superior sagittal sinus.

4. A streak of flow within the left transverse sinus (? hypoplastic sinus, ? thrombosed with partial recanalization).