Date : 00.00.00
Name of the Patient : Abc Xyz V. Bhalmn / F / 16 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O congenital deformity of the RLE with headaches, vomiting and giddiness since 1 month.
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 and Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.
CT Scan was not available.
There is seen a fairly large, extra-axial, hypointense mass lesion on the T1 Weighted images in the right cerebello-pontine angle cistern. This lesion is slightly hyperintense to CSF on all the pulse sequences. Resultant compression of the brain stem and fourth ventricle is noted, which are displaced slightly to the left of the midline. Cerebellar tonsillar herniation through the foramen magnum is also noted. Septation is noted within this lesion.
There is seen an approximately 1.8 cms diameter sized well marginated, slightly hyperintense lesion on the T1 Weighted images in the right inferior frontal/frontal region. This lesion has a hypointense rim with a slightly hyperintense centre on the proton, T2 Weighted and FLAIR images but is markedly hypointense on the Fast Scan (T2 *) images. Perilesional white matter hyperintense signal on the proton, T2 Weighted and FLAIR images is noted which may represent perilesional edema.
There are multiple varying size hypointense lesions on all the pulse sequences in the heads of the caudate nuclei and lentiform nuclei bilaterally, right thalamus and in the posterior parietal periventricular white matter on the right.
There is a diffuse, hyperintense signal on the proton, T2 Weighted and FLAIR images in the periventricular white matter bilaterally. This signal appears hypointense on the T1 Weighted images.
There is mild dilatation of both the lateral and third ventricles. The basal cisternal spaces are unremarkable. There is mild bulge of the midline structures to the left. No obvious vascular anomaly is identified on this study.
Inflammatory changes are noted in the paranasal sinuses bilaterally.
1. A fairly large, extra-axial, mass lesion in the right cerebello-pontine angle cistern with septations may represent an epidermoid cyst or an arachnoid cyst.
2. An approximately 1.8 cms diameter sized lesion in the right inferior frontal/frontal regions as described is most likely a calcified lesion. An oligodendroglioma or a germ cell tumor should be considered as differential diagnosis. Perilesional white matter hyperintense signal may represent edema.
3. Dense calcification in the head of caudate nuclei, lentiform nuclei and in the right posterior parietal deep white matter.
4. Altered signal in the periventricular white matter bilaterally is not specific for a single etiology.
Tuberous sclerosis should be considered.
A contrast enhanced scan would be worthwhile.
The previous CT Scan was not available for review.