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Date : 00.00.00

Name of the Patient : Abc Xyzi C. Golmn / F / 35 yrs.
Referred by : Dr. Abc Xyzewal.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O fever, headaches, giddiness with nausea and discharge from the left ear since 1 1/2 months.
C/O numbness over the left side of face, head and neck with decreased hearing, inability to swallow solids and loss of taste since 10-12 days.
C/O inability to see clearly from the left side since 10-12 days.

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 T1 Weighted and T2 Weighted coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an intermediate signal intensity mass lesion in the left parapharyngeal space on the T1 Weighted images. This lesion is relatively hypointense on the T2 Weighted images. This is seen to involve the medial and lateral pterygoid muscles as well as the temporalis muscle medially. There is destruction of the pterygoid plate with bulging into the pharyngeal space on the left lateral aspect. Posteriorly, there is compression upon the carotid space and displacement of the carotid sheaths postero-laterally. However, the carotid artery shows normal flow void signal on all the pulse sequences. Medially, there is mild encroachment into the retropharyngeal space. Postero-superiorly there is extension into the left infratemporal fossa with erosion of the temporal bone and intracranial extension (extradural collection) which is seen to compress upon the left temporal lobe. There is mild involvement of the clivus on the left side with slight encroachment into the inferior aspect of the left cavernous sinus. Involvement of the hard palate on the left posteriorly, is also noted. A small hypointense area is seen on the T1 Weighted images in the left paravertebral soft tissue at the C1-C2 level which is seen to turn hyperintense on the T2 Weighted images. This may represent cystic/necrotic area.
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Note is made of inflammatory changes in the left mastoid air cells, with effacement of the left torus tubarius.

There is no focal area of altered signal intensity within the brain parenchyma.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Incidental note is made of right maxillary sinusitis and mild inflammatory changes in the left ethmoidal air cells.

Enlarged, left cervical lymph nodes are also noted.

IMPRESSION :

The MRI features are suggestive of a mass lesion in the left parapharyngeal space with extensions and signal characteristics as described.

An infective lesion like tuberculosis, or a skull base neoplasm should be considered as a differential diagnosis.

A contrast enhanced scan would be worthwhile.


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