Date : 00.00.00
Name of the Patient : Abc Xyz Mithalmn / M / 20 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O drooping of the right eye with paresthesias in the LUE and LLE and bladder involvement since 2 days.
H/O typhoid 5 months ago with difficulty in walking and fever since then.
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.
5 mm thick T1 Weighted sagittal images.
3 mm thick T1 Weighted coronal images through the region of interest.
The cervical spine was screened with 5 mm thick T2 Weighted sagittal images.
There is evidence of a focal hypointense lesion on the proton, T2 Weighted and FLAIR images in the region of the tectal plate/perimesencephalic cistern on the left side. It is seen to have a diameter of approximately of 8 mms.
Foci of hypointensity on the T1 Weighted images which turn hyperintense on the proton and T2 Weighted images are seen in the right lateral aspect of the pons and right postero-lateral aspect of the medulla. A hypointense focus on the T1 Weighted images which turns hypointense with a hyperintense rim on the FLAIR images is noted in the thalamus on the right side.
Irregularly defined areas of hyperintensity on the FLAIR images are noted along the grey matter in the right temporo-occipital lobes and superior aspect of the right cerebellar hemisphere.
An area which is iso to hypointense to CSF on all the pulse sequences is noted in the right temporal lobe, more so anteriorly. This may represent an area of cystic encephalomalacia.
Areas of intermediate signal intensity on the T1 Weighted images which turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images are seen within the suprasellar cistern. The optic chiasm and pituitary stalk cannot be identified separately from this lesion.
There is moderate dilatation of the third and both lateral ventricles. Also seen is mild dilatation of the fourth ventricle.
There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
The screening images of the cervical spine are unremarkable.
The MRI features are suggestive of :
1. Mild to moderate communicating hydrocephalus with presence of exudates in the suprasellar cistern.
2. Foci of altered signal intensity within the right lateral aspect of the pons, right postero-lateral aspect of the medulla and in the thalamus on the right side. These may be ischemic in etiology or may represent granulomas.
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3. Areas of altered signal along the grey matter in the right temporo-occipital lobes and superior aspect of the right cerebellar hemisphere and these are most likely ischemic in etiology (? evolving granulomas).
4. A well-circumscribed lesion having a diameter of 8.0 mms in the region of the tectal plate/perimesencephalic cistern on the left side most likely represents a granuloma.
5. An area of cystic encephalomalacia in the right temporal lobe, more so anteriorly.
A contrast enhanced study would be worthwhile.