sb/ke/rg.
Scan No: 00000 Date : 00.00.00

Name of the Patient : Abc Xyzlata Mlmn / F /70 yrs.
Referred by : Dr. Abc XyzBhatkar.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided hemiparesis 1 1/2 years ago. Recovered partially.
Similar complaints 2 months back with speech disturbance.
Altered behavioral pattern with difficulty in walking since 8 days.
Known hypertensive. On Rx.

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.

3 mm thick T1 Weighted and T2 Weighted coronal images through the
sella and perisellar region.

5 mm thick T1 Weighted sagittal images.

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

OBSERVATION :

BRAIN :

There is volume loss in the right temporo-parieto-occipital region. There is an ill-defined, hypointense signal on the T1 Weighted images along the cortex and the subcortical white matter in the temporo-parieto-occipital region. This lesion follows CSF signal on all the pulse sequences and represents an area of cystic encephalomalacia, most likely the sequelae of a previous vascular insult. Perilesional white matter hyperintense signal on the proton, T2 Weighted and FLAIR images would represent gliotic changes.
..2/.




There is an ill-defined, hypointense signal on the T1 Weighted images in the right inferior frontal and frontal regions, right high fronto-parietal region and in the right lentiform nucleus, head of right caudate nucleus and right corona radiata. This lesion appears hyperintense on the proton, T2 Weighted and FLAIR images and represents a subacute infarct. Peripheral hyperintense signal on the T1 Weighted images around this lesion would represent paramagnetic substance deposition.

The right cerebral peduncle appears smaller in size as compared to the left and shows a hyperintense signal on the T2 Weighted and FLAIR images due to ? ischemic changes ?? Walerian degeneration.

There is mild dilatation of both the lateral and the third ventricles. The fourth ventricle is normal. There is slight prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures.

The petrous and cavernous segments of the right internal carotid artery show an intraluminal signal on all the pulse sequences.

There is widening of the floor of the sella. There is seen an approximately 2.5 x 1.5 x 2.0 cms sized mass lesion in the sella, extending into the suprasellar region. This lesion is of intermediate signal on the T1 Weighted images and appears hypointense on the T2 Weighted images. Minimal indentation on the optic chiasma is noted. There is no extension of the lesion into the cavernous sinuses bilaterally.

INTRACRANIAL & NECK MRA :

The right internal carotid artery is not visualized in its entirety, from its bifurcation from the right common carotid artery in the neck (a very small, 5.0 cms long stump is noted at the right carotid bifurcation). The right external carotid artery is slightly irregular. The left common carotid artery and its bifurcation and the left vertebral artery are unremarkable. The right vertebral artery is hypoplastic.
..3/.




- 3 - Scan-00000

There is faint visualization of the supraclinoid segment of the
right internal carotid artery (? retrograde flow) and the right middle cerebral artery. The Sylvian branches of the right middle cerebral artery are faintly visualized. The right anterior cerebral artery is most likely filling from the opposite side.

Irregularity of the basilar artery is noted. The right posterior cerebral artery is also not well-identified.

The intracranial circulation on the left side appears unremarkable.

IMPRESSION :

1. Areas of cystic encephalomalacia in the right temporo-parieto-occipital region with volume loss most likely the sequelae of a previous vascular insult.

2. Altered signal in the right inferior frontal and frontal regions, right high fronto-parietal region and in the right lentiform nucleus, head of right caudate nucleus and right corona radiata most likely represent a subacute infarct.

3. An approximately 2.5 x 1.5 x 2.0 cms sized mass lesion in the sella, extending into the suprasellar region most likely represents a pituitary adenoma.

4. Non-visualization of the right internal carotid artery nearly in its entirety would suggest thrombosis of the vessels.

5. Irregularity of the basilar artery would suggest atherosclerotic changes.

6. Mild cerebral cortical and cerebellar atrophy.