ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzang Slmn / M / 60 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided hemiparesis on 00.00.00.

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 :

Hyperintense areas on the T2 Weighted images in the right corona radiata, centrum semiovale and the periatrial deep white matter would represent areas of ischemia.

Areas which are isointense to CSF are seen in the left parieto-occipital region and the right frontal region and would represent areas of cystic encephalomalacia.

Small bright foci are noted on the T2 Weighted images in the frontal deep white matter bilaterally and in the left centrum semiovale.

There is mild dilatation of both the lateral ventricles. There is slight prominence of the cerebral cortical sulcal spaces in the fronto-parietal regions and the cerebellar folia bilaterally.

The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
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INTRACRANIAL MRA :

There is non-visualization of the petrous, cavernous and supraclinoid portion of the internal carotid artery on the right side. The anterior cerebral, middle cerebral and left internal carotid artery show normal signal, calibre and wall margins.

There appears to be slight paucity of the right MCA branches.

The basilar artery appears slightly prominent. Right vertebral artery is hypoplastic.

The visualized left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The internal carotid artery on the right side from the level of the common carotid bifurcation is not visualized. The right external and common carotid artery are unremarkable.

The left common carotid artery is visualized for about 2.2 cms from its origin. Collateral vessels are seen on the left side of the neck, which form the left internal carotid artery in the neck, distal to its bifurcation. The left external carotid artery is not visualized. Origin of left subclavian artery is also not identified.

IMPRESSION :

1. Altered signal in the right corona radiata, centrum semiovale and the periatrial deep white matter would represent areas of ischemia.
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2. Areas of cystic encephalomalacia in the left parieto- occipital region and in the right frontal region.

3. Small bright foci in the frontal deep white matter bilaterally and in the left centrum semiovale would represent ishcemic foci.

4. Non visualization of the internal carotid artery on the right side from the level of the common carotid bifurcation.

5. Visualization of the proximal 2.2 cms stump of the left common carotid artery with collateral vessels forming the left internal carotid artery. The left external carotid artery is not visualized.

6. Non-visualization of the origin of the left subclavian artery.