sb/ke/nl
Date : 00.00.00

Name of the Patient : Abc Xyz G. Vedpalmn / F / 54 yrs.
Referred by : Dr. Abc Xyziram.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O altered sensorium since 2 1/2 months.
H/O fever prior to this.
Diagnosed C/O TB meningitis. On AKT since 2 1/2 months.

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.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images (with magnetization transfer)

5 mm thick T1 Weighted sagittal images.

Limited MRV was obtained using 2D TOF sequence in the coronal plane.

OBSERVATION :

There is seen an intermediate signal intensity mass lesion on the T1 Weighted images in the region of the atrium and posterior body of the left lateral ventricle, involving the choroid plexus in this region. This lesion appears relatively hypointense on the proton, T2 Weighted and FLAIR images. The ependymal lining in that region appears slightly thickened and is also relatively hypointense on the proton, T2 Weighted and FLAIR images. Perilesional edema is noted in the left temporo-parieto-occipital lobe.


The left temporal horn is significantly dilated with resultant indentation on the left cerebral peduncle and effacement of the left ambient cistern. Hyperintense signal on the proton, T2 Weighted and FLAIR images is noted in the left cerebral peduncle. There is compression of the left lateral and third ventricles with shift of the midlline to the right. Effacement of the sulcal spaces and the left cerebral hemisphere is noted.

Mild fullness of the right lateral ventricle is also noted.

The fourth ventricle is normal. The rest of the basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.

After administration of contrast, the lesion in the atrium and posterior body of the left lateral ventricle appears as a conglomeration of multiple ring enhancing lesion. Enhancement of the wall of the left lateral ventricle including the left temporal horn is also noted. No significant meningeal enhancement is identified. There are no obvious basal exudates noted.

The limited venogram study shows normal flow signal in the dural venous sinuses.

IMPRESSION :

1. Conglomeration of multiple ring enhancing lesions in the atrium and posterior body of the left lateral ventricle involving the choroid plexus as described most likely represent multiple granulomas following the signal characteristics of tuberculomas. There is resultant mass effect as described.
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2. Trapped temporal horn of the left lateral ventricle.

3. Enhancement of the wall of the left lateral ventricle suggest ventriculitis.

As compared to the previous CT Scan dated 00.00.00, there is an increase in the ring enhancing lesions, the perilesional edema, size of the left temporal horn and the resultant mass effect.