/3 Date : 00.00.00
Name of the Patient : Abc Xyzkumar Bartlmn / M / 46 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O altered speech, memory impairment, tremors in the RUE and tingling in the LUE and LLE since 2 years.
The brain was screened with 5 mm thick T2 Weighted axial images, 5 mm thick Fast Scan (T2 *) coronal images and 5 mm thick T1 Weighted sagittal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
There is seen a well marginated, approximately 0.8 x 3.0 x 2.5 cms sized hyperintense mass lesion on the T1 Weighted images in the left external capsular region. This lesion remains hyperintense on the T2 Weighted images and shows evidence of a peripheral hypointense rim, more pronounced on the Fast Scan (T2 *) images. There is no perilesional edema. Mild effacement of the left Sylvian cistern is noted.
An ill-defined hyperintense signal on the T2 Weighted images is noted in the ponto-medullary junction on the left, anteriorly. This most likely represents an ischemic lesion.
Lacunar infarcts are noted in the thalami bilaterally, pons, right corona radiata, left frontal deep white matter and in the right posterior parietal region.
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Linear hypointense signal, more pronounced on the Fast Scan (T2 *) images is noted in the right posterior parietal periventricular white matter (scans 104.4 & 5).
Mild fullness of both the lateral and third ventricles is noted. The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Inflammatory changes are noted in the left mastoid air cells.
INTRACRANIAL MRA :
There is ectasia of the vertebro-basilar system. The right vertebral artery is hypoplastic.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The right vertebral artery in the neck also appears hypoplastic.
The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
1. A well marginated, approximately 0.8 x 3.0 x 2.5 cms sized mass lesion in the left external capsular region follows the signal characteristics of a late subacute hematoma.
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2. Altered signal in the ponto-medullary junction on the left, anteriorly most likely represents an ischemic lesion.
3. Lacunar infarcts in the thalami bilaterally, pons, right corona radiata, left frontal deep white matter and in the right posterior parietal region.
4. Linear hypointense signal, more pronounced on the Fast Scan (T2 *) images in the right posterior parietal periventricular white matter most likely represents residual hemosiderin, probably the sequelae of a previous haemorrhage.
5. Ectatic vertebro-basilar system with a hypoplastic right vertebral artery.
6. No other significant abnormality is detected on the intracranial and neck MRA on this study.