Date : 00.00.00
Name of the Patient : Abc Xyzh lmn / M / 52 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzdi.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O loss of memory since 00.00.00.
C/O convulsions since 00.00.00.
Known diabetic and chronic alcoholic.
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.
There are multiple, well-marginated, predominantly hyperintense lesions on the T1 Weighted images in the frontal and temporal lobes on the right and the temporo-parietal region on the left. These lesions appear relatively hypointense on the T2 Weighted images and bloom on the Fast Scan (T2 *) images. There is perilesional white matter hyperintense signal on the proton, T2 Weighted and FLAIR images which represents perilesional edema. Effacement of the sulcal spaces is noted in the right fronto-temporal region with resultant indentation on the frontal horn of the right lateral ventricle and mild bulge of the anterior interhemispheric fissure to the left.
There is slight prominence of the subdural space in the left fronto-temporo-parietal convexity. The fluid in this region is slightly hyperintense to CSF on all the pulse sequences. A predominantly more hyperintense signal on the T1 Weighted images is noted in the subdural space in the left temporal region.
There is an ill-defined, hyperintense signal on the T1 Weighted images in the globus pallidus bilaterally, extending into the cerebral peduncles bilaterally. This signal appears isointense to the normal grey matter on the proton and T2 Weighted images.
The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.
1. Multiple altered signal intensity lesions in the right frontal and temporal lobes and in the left temporo-parietal region as described, follow the signal characteristics of subacute haemorrhage. These most likely represent multiple haemorrhagic contusions (known alcoholic). There is however, no definite h/o head trauma, presently. The possibility of amyloid angiopathy, multiple vascular malformations or multiple haemorrhagic metastasis seems less likely.
2. A small subdural collection (maximum width of 5.0 mms) in the left fronto-temporo-parietal region.
3. Altered signal in the globus pallidus bilaterally, extending into the cerebral peduncles may suggest a paramagnetic substance deposition. Hepato-cerebral syndrome should be ruled out, in the given clinical setting.