ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzi lmn / F / 70 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O 3 episodes of seizures since 1 month.
Known hypertensive.

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 :

There are ill-defined, hyperintense areas in the fronto-parietal periventricular deep white matter, bilateral corona radiata and left centrum semiovale on the T2 Weighted images and are suggestive of areas of ischemia/infarction. Similar areas are noted in the globus pallidi bilaterally, pons and the right lentiform nucleus.

Lacunar infarcts which are slightly hyperintense to CSF on all the pulse sequences are seen in the right cerebellar hemisphere, head of the caudate nucleus on the right side, anteriorly in the left internal capsule and the left corona radiata.

There is moderate dilatation of both the lateral and third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulcal spaces in the fronto-parietal regions bilaterally.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

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Incidental note is made of inflammatory changes in the right maxillary sinus, ethmoidal air cells and sphenoid sinus.

INTRACRANIAL MRA :

There is slight irregularity of the supraclinoid segment of the right internal carotid artery, right anterior cerebral artery and the right posterior cerebral artery.

There is seen an approximately 3.0 mm diameter sized well-defined, saccular lesion at the tip of the fronto-polar artery on the right. This is suspicious for an aneurysm.

The petrous and cavernous segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized left anterior cerebral, middle cerebral, basilar, vertebral and left posterior cerebral arteries also show normal signal, calibre and wall margins. No vascular malformation is identified. Tortuosity of the vertebro-basilar system is noted.

NECK MRA :

The right vertebral artery seems to arise from the innominate artery prior to its bifurcation into the common carotid and right subclavian artery. Tortuosity of the common carotid arteries and the internal and external carotid arteries is noted. The carotid bifucations are unremarkable.

IMPRESSION :

1. Altered signal in the fronto-parietal periventricular deep white matter, bilateral corona radiata, left centrum semiovale, in the globus pallidi bilaterally, pons and the right lentiform nucleus are suggestive of areas of ischemia/infarction.

2. Lacunar infarcts in the right cerebellar hemisphere, head of the caudate nucleus on the right side, anteriorly in the left internal capsule and the left corona radiata.
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3. Slight irregularity of the supraclinoid segment of the right internal carotid artery, right anterior cerebral artery and the right posterior cerebral artery may be due to atherosclerotic changes.

4. An approximately 3.0 mm diameter sized well-defined, saccular lesion at the tip of the fronto-polar artery on the right is suspicious for an aneurysm.

5. Tortuosity of the neck vessels.