Name of the Patient : Abc XyzHaroon Anlmn / M / 65 yrs.
Referred by : Dr. Abc Xyzankhla.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches and weakness of the left side of the face.
C/O diminished vision and diplopia.

EXAMINATION :

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

5 mm thick T1 Weighted and T2 Weighted axial images.

5 mm thick FLAIR and 7 mm thick Fast Scan (T2 *) coronal images.

5 mm thick T1 Weighted sagittal images.

3 mm thick T1 Weighted and STIR coronal images.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

The marrow of the clivus appears hypointense when compared to the normal marrow signal on the T1 Weighted images, remains predominantly hypointense on the T2 Weighted images and appears heterogeneously hyperintense on the STIR images.

There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the sphenoid sinus and in the left cavernous sinus which appears heterogeneously hyperintense on the STIR images. Resultant encasement of the cavernous segment of the left internal carotid artery is noted. Extension of the lesion upto the left orbital apex and left superior orbital fissure is noted.
Scan-00008


The left optic nerve in the orbital apex shows a subtle hyperintense signal on the STIR images and this may represent edema/ischemia (se/im : 108/14).

There is suspicious extension of the soft tissue lesion into the right cavernous sinus. Probable erosion of the floor of the sella is noted.

There is no focal area of altered signal intensity within the brain parenchyma, pre se, on this study.

There is mild dilatation of both the lateral, third and the fourth ventricles. There is prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally.

There is no shift of the midline structures.

Incidentally noted is a deviated nasal septum to the left.

IMPRESSION :

Altered marrow signal of the clivus with a soft tissue lesion in the sphenoid sinus and left cavernous sinus (and probably in the right cavernous sinus) as described is not specific for a single etiology. A sphenoid sinus carcinoma, round cell tumors, metastasis or an infective etiology (?? fungal) may be considered in the differential diagnosis.