Name of the Patient : Abc Xyza Qulmn / M / 46 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O single episode of giddiness with loss of consciousness for 15-16 minutes.
C/O left sided headaches.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial and FLAIR coronal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There are prominent sulci in the left parietal region with adjacent hyperintense signal on the T2 Weighted and FLAIR images and these may represent gliotic changes, probably the result of a previous vascular insult.

There are small bright areas on the T2 Weighted and FLAIR images in the frontal and periatrial white matter and corona radiata on the left side. These are probably ischemic in etiology.

Lacunar infarcts (iso to hyperintense to CSF) are seen within the left lentiform nucleus and left corona radiata with focal dilatation of the adjacent body of the left lateral ventricle.





- 2 - Scan-00007

There is fullness of both the lateral ventricles. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

Inflammatory changes are seen within the maxillary sinuses, ethmoidal air cells and frontal sinus.

INTRACRANIAL MRA :

There is irregularity and flow signal attenuation of the P2 segment of the right posterior cerebral artery and the P3 segments of both posterior cerebral arteries.

There is irregularity and flow signal attenuation of the distal M1 segment of the left middle cerebral artery and the proximal A2 segment of the left anterior cerebral artery. There is a slight paucity of the Sylvian branches of both middle cerebral arteries.

There is narrowing of the supraclinoid and cavernous segments of the left internal carotid artery and at the junction of the supraclinoid and cavernous segments of the right internal carotid artery.

The overall calibre of the left internal carotid artery is smaller as compared to the opposite side.

The overall calibre of the left vertebral is smaller as compared to the opposite side.

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- 3- scan-00007

The petrous, cavernous and supraclinoid segments of the right internal carotid artery and the petrous segment of the left internal carotid artery show normal signal and calibre. The visualized right anterior cerebral, basilar and right vertebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The overall calibre of the left internal and left common carotid arteries is smaller as compared to the opposite side.

There is narrowing of the origin of both the internal carotid arteries.

IMPRESSION :

1. Volume loss with altered signal in the left parietal region may represent gliotic changes, probably the result of a previous vascular insult.

2. Areas of altered signal in the frontal and periatrial white matter and corona radiata on the left side are probably ischemic in etiology.

3. Lacunar infarcts within the left lentiform nucleus and left corona radiata with focal dilatation of the adjacent body of the left lateral ventricle.

4. Irregularity and flow signal attenuation of the P2 segment of the right posterior cerebral artery and the P3 segments of both posterior cerebral arteries.
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- 4 - Scan-00007

5. Irregularity and flow signal attenuation of the distal M1 segment of the left middle cerebral artery and the proximal A2 segment of the left anterior cerebral artery with slight paucity of the Sylvian branches of both middle cerebral arteries.

6. Narrowing of the supraclinoid and cavernous segments of the left internal carotid artery and at the junction of the supraclinoid and cavernous segments of the right internal carotid artery.

7. Smaller, overall calibre of the left internal carotid artery as compared to the opposite side.

8. Smaller overall calibre of the left vertebral as compared to the opposite side, ? normal variant.