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ke/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Jalmn / F / 50 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O vomiting (4 times) with seizures (single episode) with high B.P. on 00.00.00.
C/O severe headaches with inability to open eyes since then.

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.

4 mm thick T1 Weighted coronal images.

OBSERVATION :

There is thickening of the grey matter in the left temporal lobe, medially with involvement of the hippocampus and appears hypointense on the T1 Weighted images. This is seen to turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images. Anteriorly, there is similar involvement of the left gyrus rectus (inferior frontal lobe) and which shows a subtle hyperintense signal within it on all the pulse sequences and may represent altered blood. Superiorly, altered signal is also seen within the left lentiform nucleus and the genu of the internal capsule on the left side. There is mass effect with compression upon the temporal horn and the body of the left lateral ventricle.






A sliver of hyperintense signal on the T1 Weighted images is seen to overlie the left temporal lobe within the left Sylvian fissure and along the right temporal lobe and would represent extracellular methaemoglobin (subacute blood). Fluid-fluid levels are seen in the occipital horns of both the lateral ventricles.

Foci of hyperintensity on the FLAIR images are seen within the white matter in the frontal lobes bilaterally (? ischemic).

Turbulence is seen in the fourth ventricle, aqueduct and the third ventricle.

There is slight fullness of the ventricular system.
There is no shift of the midline structures.

Incidental note is made of mild inflammatory changes in the left mastoid air cells.

IMPRESSION :

The MRI features are suggestive of altered signal within the left fronto-temporal lobes and may represent a haemorrhagic infarct (encephalitis may have similar features). Blood is also seen in the subarachnoid space as described and an aneurysm should be excluded.


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