Date : 00.00.00
Name of the Patient : Abc Xyzlmn / F / 78 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O tingling on the right side of the body with altered sensorium since 6 days.
Known hypertensive. On Rx.
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.
There is seen a fairly large, subdural collection overlying the right cerebral convexity with a maximum width of about 2.0 cms. The bulk of this lesion is nearly isointense to gray matter on the T1 Weighted images but appears significantly more hyperintense on the proton, T2 Weighted and FLAIR images. Posteriorly, within the lesion, there is a hyperintense signal on all the pulse sequences which may suggest recent haemorrhage. A loculated pocket is noted in the right parietal region. There is resultant compression of the underlying brain parenchyma and the right lateral and the third ventricles with subfalcine herniation of the ventricles to the left, distortion of the upper brainstem axis and effacement of the cortical sulcal spaces. Transtentorial herniation of the right medial temporal pole is also noted.
There is an ill-defined, hyperintense signal on the proton, T2 Weighted and FLAIR images in the head of right caudate nucleus and right lentiform nucleus. This lesion appears slightly hypointense to normal white matter on the T1 Weighted images.
There is seen a much smaller, similar (as described above) signal intensity, subdural collection overlying the left cerebral hemisphere with a maximum width of about 1.2 cms in the left high parietal region.
There is mild dilatation of the left lateral ventricle. There is an ill-defined hyperintense signal on proton, T2 Weighted and FLAIR images in the periventricular white matter around the left lateral ventricle. Similar signal is also noted in the head of left caudate nucleus. This signal appears hypointense to normal white matter on the T1 Weighted images.
There is prominence of the cerebellar folia bilaterally with mild fullness of the fourth ventricle.
No obvious vascular anomaly is identified on this study.
Inflammatory changes are noted in the sphenoid sinus on the left.
1. A fairly large, acute on chronic subdural hematoma overlying the right cerebral convexity with a maximum width of about 2.0 cms. with resultant mass effect.
2. A smaller, acute on chronic subdural hematoma overlying the left cerebral hemisphere.
3. Altered signal in the head of caudate nuclei bilaterally and right lentiform nucleus may represent ischemic changes.
4. Mild dilatation of the left lateral ventricle with periventricular white matter hyperintense signal on proton, T2 Weighted and FLAIR images may represent a trapped ventricle with periventricular CSF ooze. Alternatively, the left periventricular white matter altered signal may represent ischemic changes.