Date : 00.00.00
Name of the Patient : Abc Xyzlmn / M / 38 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O high blood pressure with left hemiparesis on 00.00.00. Patient is in subconscious state.
Known hypertensive. On Rx.
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 and Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.
There is a large lesion which measures approximately 6.2 x 4.5 x 6.1 cms in the right lentiform nucleus/external capsular region. Superiorly this lesion is seen to extend into the right corona radiata and inferiorly into the right temporal lobe. This lesion has a thick hyperintense periphery with a hypointense centre on the T1 Weighted images. The periphery is seen to remain hyperintense and the centre heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images and would represent hemoglobin breakdown products. There is a complete hypointense rim better appreciated on the Fast Scan (T2 *) images which represents haemosiderin rim and the lesion in toto represents a subacute hematoma. Hypointense areas peripherally which are slightly hyperintense to CSF on the T1 Weighted images are seen
to turn hyperintense on the proton and T2 Weighted images would represent serum due to clot retraction. There is dissection of the hematoma in the body of the right lateral ventricle. There is surrounding edema in the right cerebral hemisphere region with effacement of the adjacent sulci and compression upon the right lateral and the third ventricles and shift of the midline structures to the left. There is effacement of the right Sylvian fissure.
Hypointense areas are seen within the thalamus, caudate nucleus, subthalamus, midbrain, pons and the occipital lobe on the right side on the T1 Weighted images which are seen to turn hyperintense on the proton, T2 Weighted and FLAIR images would represent an infarct.
There is dilatation of the left lateral and the fourth ventricle with periventricular CSF ooze.
There is prominence of the cerebellar folia bilaterally.
No obvious vascular anomaly is identified on this study.
Incidental note is made of inflammatory changes in the mastoid air cells, sphenoid and maxillary sinus.
The MRI features are suggestive of :
1. A large subacute hematoma measuring approximately 6.2 x 4.5 x 6.1 cms in the right lentiform nucleus and external capsular region with extensions as described.
2. Altered signal within the thalamus, caudate nucleus, subthalamus, midbrain, pons and the occipital lobe on the right side would represent an infarct.