hs/sb
/6 Date : 00.00.00

Name of the Patient : Abc XyzNalmn / M / 72 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided headaches, intermittent weakness, paresthesias in the LUE and BLE and sudden onset of arrest of speech for 1-2 hours since 2 months.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images.

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

OBSERVATION :

A well-defined, area which is near isointense to CSF on the T2 Weighted images is seen within the left lentiform nucleus and extends into the left corona radiata. This would represent a lacunar infarct. A smaller lacunar infarct is noted within the left occipital lobe and left centrum semiovale. There is ex-vacuo dilatation of the left lateral ventricle.

Posterior parietal periventricular white matter ischemic lesions are noted bilaterally.

There is marked prominence of the left Sylvian fissure and cerebral cortical spaces in the left temporal lobe which would suggest volume loss, probably the result of a previous vascular insult.

There is prominence of the right Sylvian fissure, cerebellar folia, cerebral cortical sulcal spaces and basal cisternal spaces. Also seen is mild fullness of the third and the right lateral ventricles.

There is no shift of the midline structures.

INTRACRANIAL MRA :

The calibre of the left internal carotid artery is seen to be slightly smaller from its origin as compared to the opposite side.
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A very small segment of the proximal portion of the M1 segment of the left middle cerebral artery is visualized. The rest of the left middle cerebral artery is not seen.

Attenuated flow signal is seen within the left vertebral artery, distally. This may represent retrograde flow as the rest of the left vertebral artery from its origin is not identified.

The left posterior cerebral artery is not well-visualized. The right posterior cerebral artery and the posterior communicating arteries are slightly prominent.

The anterior cerebral arteries, basilar artery, carotid bifurcation, the right internal carotid artery,
right vertebral artery and both common carotid arteries are unremarkable.

IMPRESSION :

The MRI/MRA features are suggestive of :

1. Lacunar infarcts within the left lentiform nucleus extending into the left corona radiata, the left occipital lobe and left centrum semiovale.

2. Marked prominence of the left Sylvian fissure and cerebral cortical sulcal spaces
in the left temporal lobe. This would represent volume loss, most likely the result of a previous vascular insult.

3. Non-visualization of the distal left middle cerebral and left vertebral arteries and the left posterior cerebral artery.