ke/sb/rg.
/00000 Date : 00.00.00

Name of the Patient : Abc XyzKlmn / M / 49 yrs.
Referred by : Dr. Abc Xyzndel.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O numbness in the RUE and right side of the face.
Also C/O speech disturbances since 1 month.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images, 3 mm thick FLAIR coronal images and 5 mm thick T1 Weighted sagittal images.

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

OBSERVATION :

There is an ill-defined hypointense area on the T1 Weighted images in the left frontal region. This is seen to follow CSF signal characteristics on all the pulse sequences. Hyperintense areas are noted at the periphery of this lesion on the T2 Weighted and FLAIR images and may repersent area of gliosis. Subtle hyperintense signal is seen on the T1 Weighted images at the periphery of this lesion which may represent altered blood/paramagnetic substances.

There is slight prominence of the cerebral cortical sulci.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

Inflammatory changes are noted in the sphenoid sinus.

INTRACRANIAL MRA :

There is slight irregularity and narrowing of the cavernous portion of the left internal carotid artery.
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Slight narrowing of the P1 segment of the left posterior cerebral artery is noted.

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

NECK MRA :

There is a small filling defect in the posterior aspect in the
internal carotid arteries bilaterally just distal to the common carotid bifurcation, which may be flow related artifacts.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

The MRA features are suggestive of :

1. An area of cystic encephalomalacia in the left frontal region, most likely the sequelae of previous vascular insult.

2. Slight irregularity and narrowing of the cavernous portion of the left internal carotid artery.

3. Slight narrowing of the P1 segment of the left posterior cerebral artery.

4. A small filling defect in the posterior aspect in the
internal carotid arteries bilaterally just distal to the common carotid bifurcation, which may be flow related artifacts.