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ke/bv/nl/nl
/00006 Date : 21/00.00.00

Name of the Patient : Abc Xyz Ylmn / F / 40 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O weakness of the LUE and LLE with tingling in the LUE and LLE since 15 days.
H/O fever 20 days back.
H/O hypertension.

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.

5 mm thick T1 Weighted sagittal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There are subtle hypointense areas in the right frontal and posterior parietal deep white matter on the T1 Weighted images. These are seen to turn hyperintense on the proton, T2 Weighted and FLAIR images. The grey matter in the precentral gyrus also appears to be involved by the pathology.










On administration of contrast, there are ring enhancing lesions in the right high parietal region. Enhancement of the meninges in the sulcal spaces on the right side is noted. Few disc enhancing lesions are also seen in the fronto-parietal deep white matter.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Note is made of ethmoidal sinusitis.

IMPRESSION :

The MRI features are suggestive of multiple ring and disc enhancing lesions with leptomeningeal involvement in the right frontal and posterior parietal deep white matter and grey matter and in the precentral gyrus on the right side. The radiological features favours multiple granulomas.

The possibility of metastatic deposits seems less likely.

A follow-up with contrast would be worthwhile.



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