sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyza lmn / M / 66 yrs.
Referred by : Dr. Abc Xyzh Shah / Dr. Abc XyzMomaya.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O cataract surgery of left eye one month back.
Now C/O decreased vision with swelling on the left side.
Known diabetic.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

3 mm thick T1 Weighted and STIR coronal images.

OBSERVATION :

There is an ill-defined, hyperintense lesion on the proton and T2 Weighted images in the left cerebellar hemisphere. This lesion appears hypointense on the T1 Weighted images.

There is thickening of the gyri in the inferior frontal and frontal regions bilaterally. These gyri appear relatively hypointense to normal grey matter on the T1 Weighted images and appear hyperintense on the proton and T2 Weighted images. Hyperintense signal on the proton and T2 Weighted images is also noted in the white matter in the frontal lobes bilaterally. Ill-defined hyperintense signal on the proton and T2 Weighted images is also noted in the posterior parietal deep white matter bilaterally and in bilateral centrum semiovale.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.




There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the left cavernous sinus, posteriorly. This lesion appears hyperintense on the STIR images. Ill-defined, hyperintense signal on the STIR images is also noted in the orbital fat on the left, periorbital region and in the soft tissues of the left half of the face.

Inflammatory tissue is noted in the sphenoid sinus, right frontal sinus and in the right maxillary antrum.

The nasal turbinates appear slightly atrophied. ? surgical intervention to the nasal septum is noted.

IMPRESSION :

1. Altered signal in the left cerebellar hemisphere is not specific for a single etiology. This may represent an ischemic lesion or a demyelinating plaque.

2. Altered signal along the cortex in the left inferior frontal and frontal regions and left anterior temporal region as described may represent an ischemic lesion.

3. Soft tissue lesion in the left cavernous sinus, posteriorly, may represent an inflammatory lesion. Altered signal in the orbital fat on the left, periorbital region and in the soft tissues of the left half of the face also represents inflammatory changes.

4. Inflammatory changes in the sphenoid sinus and right maxillary antrum.

In a known diabetic with inflammatory changes in the paranasal sinuses as described and left orbital and periorbital cellulitis, mucormycosis should be ruled out.

A contrast enhanced scan would be worthwhile to delineate the left cavernous sinus lesion and basal meningitis, if any.