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Date : 00.00.00

Name of the Patient : Abc Xyzath Talmn / M / 51 yrs.
Referred by : Dr. Abc Xyzlankar.
Examination : M.R.I. of the Brain with optic.

CLINICAL PROFILE :

H/O left sided mucormycosis since 10 days with tooth extraction on 00.00.00.
C/O ptosis, proptosis and progressive diminished vision since last 3 days. Also C/O headaches and tinnitus (left sided) since 10 years.
Known hypertensive/diabetic. On Rx.

EXAMINATION :

M.R.I of the brain and orbits was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

5 mm thick FLAIR coronal images.

4 mm thick T1 Weighted and STIR coronal images.

OBSERVATION :

Areas of intermediate signal intensity on the T1 Weighted and STIR images are noted within the superior orbital fissure and optic canal on the left side. The extraoccular muscles of the left orbit are seen to be bulky and slightly hyperintense on the STIR imags as compared to the opposite side. Note is made of proptosis on the left side.

Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted and STIR images are seen within the left maxillary sinus and the ethmoidal air cells and sphenoid sinus on the left side. Areas of similar signal intensity are seen to involve the left infratemporal fossa. Mild inflammatory changes are noted in the frontal sinus and the mastoid air cells bilaterally.
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There is no focal area of altered signal intensity in the brain parenchyma on this scan.

There is mild prominence of the cerebral cortical sulci bilaterally. Also seen is slight fullness of the third and both the lateral ventricles. The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

The MRI features are suggestive of :

1. A lesion within the left superior orbital fissure and optic canal with bulky extraoccular muscles on the left side as described most likely represents an infective pathology.

2. Inflammatory changes within the left maxillary sinus and the ethmoidal air cells and sphenoid sinus on the left side and
in the left infratemporal fossa and mild inflammatory changes in the frontal sinus and the mastoid air cells bilaterally.

In the given clinical setting of diabetis, a fungal infective etiology like mucormycosis should be excluded.
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