sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzar P. Achrlmn / M / 38 yrs.
Referred by : Dr. Abc Xyzwant.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches with diminished vision in the right eye and vomiting since 1 year.
H/O VP shunt done 8 days back.

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.

5 mm thick T1 Weighted and T2 Weighted sagittal images.

OBSERVATION :

There is seen a fairly large, approximately 3.9 x 3.9 x 5.0 cms sized well-marginated heterogeneous signal intensity mass lesion in the posterior fossa in the midline and slightly more to the right. This lesion is most likely within the fourth ventricle. The solid component of this lesion is of intermediate signal intensity on the T1 Weighted images but appears relatively hypointense on the proton and T2 Weighted images. The cystic component of the lesion is isointense to CSF on all the pulse sequences. There is no perilesional edema. The brainstem is seen to be displaced slightly anteriorly by the lesion. There is cerebellar tonsillar herniation through the foramen magnum.






Burrholes are noted in the right frontal and right posterior parietal region. A shunt tube is seen to traverse the right posterior parietal lobe, with its tip lying in the body of the right lateral ventricle. Both the lateral and third ventricles appear collapsed.

Small bright foci on the proton, T2 Weighted and FLAIR images are noted in the posterior parietal periventricular white matter bilaterally, right frontal deep white matter and right centrum semiovale.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Incidentally noted is a syrinx in the cervical cord over C2 to C4 vertebral levels.

Screening T1 Weightd sagittal images of the dorsal spine reveal slightly wedged lower dorsal vertebrae, which may be post-traumatic.

IMPRESSION :

An approximately 3.9 x 3.9 x 5.0 cms sized heterogeneous signal intensity mass lesion in the posterior fossa in the midline and to the right as described is not specific for a single etiology. The differential diagnosis would include :

1. An intrafourth ventricular mass lesion, most likely a primitive neuroectodermal tumor.

2. A cerebellar astrocytoma.

3. Ependymoma/Subependymoma.

Patient is status post-shunt.

A syrinx is noted in the cervical cord over C2 to C4 vertebral levels.