ke/sb
Date : 00.00.00
Name of the Patient : Abc XyzBhlmn / F / 45 yrs.
Referred by : Dr. Abc Xyzhacker.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O headaches with occasional vomiting since 6 months which has increased since 3 months.
C/O bilateral papilloedema.
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, 5 mm thick T1 Weighted axial images and 5 mm thick T1 Weighted coronal images (with magnetization transfer) and 5 mm thick T1 Weighted sagittal images were obtained.
OBSERVATION :
There is an extracerebral (extradural)_ collection along the right frontal convexity which measures 2.0 cms in its maximum width and 5.5 cms in its antero-posterior dimensions. This lesion is of mixed signal intensity characteristics on the T1 Weighted images and is seen to turn predominantly hypointense on the proton, T2 Weighted and FLAIR images. There is resultant compression upon the underlying brain parenchyma.
There are ill-defined hypointense areas in the right frontal region adjacent to above mentioned extradural lesion on the T1 Weighted images which are seen to turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images. There is surrounding white matter edema with mass effect and compression upon the body and frontal horn of the right lateral ventricle. There is resultant shift of the midline structures to
..2/.
the left with compression upon the body and frontal horn of the left lateral and third ventricles. There is effacement of the right Sylvian fissure and the adjacent cortical sulcal spaces. The edema is also seen to encroach into the external capsule and the clostrum and genu of the corpus callosum on the right side.
After administration of contrast, there is thin, peripheral homogeneous enhancement of the right frontal extradural lesion. Subtle enhancement of the adjacent meninges is also noted. Nodular enhancement which is irregular in outline is seen in the right frontal region just medial to the extradural lesion. Enhancement of the meninges in the frontal regions bilaterally is noted with subtle enhancement along the interhemispheric fissure.
There is slight dilatation of the posterior part of the body and occipital horn of the left lateral ventricle. The fourth ventricle is normal. No obvious vascular anomaly is identified on this study.
IMPRESSION :
The MRI features are suggestive of
1. An extradural collection in the right frontal region measuring 2.0 cms. in its maximum width and 5.5 cms in its antero-posterior dimensions, most likely a chronic inflammatory lesion.
2. Nodular, enhancing lesions, along the medial margin of the above described extracerebral lesion in the right frontal lobe are most likely granulomas.
The signal characteristics of the above described extracerebral lesion and nodular enhancing lesions, favours the diagnosis of tuberculous lesions. The possibility of a neoplasm seems less likely.