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Date : 00.00.00

Name of the Patient : Abc Xyzai P. Nlmn / F / 40 yrs.
Referred by : Dr. Abc Xyzwant.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches with diminished vision of the left eye since 3 months.
C/O right C.P. angle tumor.
VP shunt done 10 days back.

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 FLAIR coronal images.

3 mm thick T1 Weighted coronal images.

MR cisternogram was obtained in the coronal plane.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is a large fairly well-defined extra-axial mass lesion in the right cerebello-pontine angle cistern and which measures approximately 6.1 x 5.8 x 5.3 cms. This lesion has a predominant cystic portion which is hyperintense to CSF on all the pulse sequences and is located in the posterior aspect of the entire lesion (? an associated arachnoid cyst). A small solid portion is seen anteriorly at the root exit zone of the seventh and eighth cranial nerve complex on the right side and measures approximately 1.5 x 2.2 x 2.0 cms. This portion is hypointense to white matter but isointense to grey matter on the T1 Weighted images and is heterogeneously hyperintense on the proton and


T2 Weighted images and hyperintense on the FLAIR images. There is slight extension into the internal auditory canal on the right side. There is gross mass effect with compression of the right lateral aspect of the pons, medulla, right cerebellar hemisphere and the right middle cerebellar peduncle and the right postero-lateral aspect of the fourth ventricle. There is resultant shift of the midline structures to the left. Cerebellar tonsillar herniation is also noted (which is seen to lie below the foramen magnum level).

The seventh and eight cranial nerve complex on the left side is unremarkable.

Burrholes are noted in the right frontal and left parietal regions. A ventriculostomy tube is seen to traverse to the left parietal region and the tip is seen to lie in the right corona radiata. Hyperintense areas are seen along the course of the tube on the T2 Weighted and FLAIR images.

Hyperintense areas are seen in the periatrial deep white matter on the proton, T2 Weighted and FLAIR images and are isointense to white matter on the T1 Weighted images and may represent areas of ischemia/infarction.

There is mild dilatation of both the lateral and third ventricles. No obvious vascular anomaly is identified on this study.

IMPRESSION :

The MRI features are suggestive of an extra-axial mass lesion in the right cerebello-pontine angle cistern which measures approximately 6.1 x 5.8 x 5.3 cms. which most probably represents an acoustic neurinoma.


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