Date : 00.00.00
Name of the Patient : Abc XyzAli lmn / F / 40 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
Operated for a suprasellar and planumsphenoidal meningioma on 00.00.00. Patient developed right hemiparesis. 1 episode of seizure and diminished vision in the right eye since 1 day and drowsiness since 1 to 2 days.
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
4 mm thick T1 Weighted, STIR and Fast Scan (T2 *) coronal images.
4 mm thick T1 Weighted sagittal images.
There is evidence of a right frontal craniotomy with post-operative changes in the soft tissues in the right frontal region. A small, epidural collection is also noted in the right frontal region, deep to the craniotomy flap.
There is seen an ill-defined, hyperintense signal on the proton and T2 Weighted images in the inferior frontal cortex, bilaterally, right frontal cortex, left parathird ventricular region, left cerebral peduncle and in the posterior limb of the left internal capsule. This lesion appears hypointense to normal grey matter on the T1 Weighted images. A focal hyperintense signal on the T1 Weighted images in the left inferior frontal region may represent hemoglobin breakdown products.
There is an ill-defined, hyperintense signal on the T1 Weighted images in the suprasellar cistern, which remains hyperintense on the proton, T2 Weighted and STIR images. The pituitary stalk is not well-identified from the lesion which is seen to indent the optic chiasma to the left of the midline. The left optic nerve appears slightly atrophied and shows a hyperintense signal on the STIR images in its proximal segment. The pituitary gland is well identified on the present study. The cavernous sinuses on either side are unremarkable. The visualized right optic nerve shows normal signal.
There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
Inflammatory changes are noted in the mastoid air cells bilaterally. Subgaleal edema is seen in the high parietal region.
1. Post-operative status.
2. Altered signal in the inferior frontal cortex, bilaterally, right frontal cortex, left parathird ventricular region, left cerebral peduncle and in the posterior limb of the left internal capsule as described, most likely represent ischemic changes. (It is difficult to distinguish the frontal lesions from post-operative changes).
3. Altered signal in the suprasellar cistern, more to the left of the midline, may represent haemorrhage/hemostatic material like gel foam, in the given clinical setting.
4. Left optic nerve atrophy. Visualized right optic nerve is unremarkable.
- 3 - scan-00007
As compared to the previous MRI (study no:00009) dated 00.00.00, the patient is now status post-operative with near complete excision of the previously identified tumor. There is no significant change in the size of the ventricles on the present study.