Date : 00.00.00
Name of the Patient : Abc XyzDamlmn / F / 42 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O seizures on 00.00.00.
The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick T1 Weighted sagittal images.
Intracranial MRA was performed with 3D TOF sequence.
Intracranial MRV was performed using 2D TOF sequences in the axial, coronal and sagittal planes.
There is an ill-defined predominant hypointense signal on the T1 Weighted images in the left temporo-parietal and high parietal regions. This lesion remains predominantly hypointense on the T2 Weighted images with focal hyperintense areas within. On the T1 Weighted images faint hyperintense signal is noted in some regions. There is perilesional white matter edema with sulcal space effacement and indentation on the atrium of the left lateral ventricle. The third ventricle is also effaced with shift of the midline structures to the right.
The fourth ventricle is normal. The basal cisternal spaces are unremarkable.
There is loss of normal flow void signal in the dural venous sinuses (superior sagittal, right transverse and sigmoid sinuses) with a hyperintense signal on the T1 Weighted images within these sinuses, which appears relatively hypointense on the T2 Weighted images.
INTRACRANIAL MRV :
On the MRV, there is loss of normal flow signal in the superior sagittal sinus, right transverse sinus and to some extent in the right sigmoid sinus. The normal flow signal is however noted in the straight sinus, torcula, left transverse and sigmoid sinuses and in the internal cerebral veins and vein of Galen.
INTRACRANIAL MRA :
The left middle cerebral artery and its Sylvian branches appear slightly stretched due to the mass effect of the left cerebral hemispheric lesion.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, right middle cerebral, basilar, vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
1. Lesion in the left temporo-parietal and high parietal regions, most likely represents an haemorrhagic infarct, probably venous, in view of the loss of normal flow signal in the dural sinuses as described.
2. Loss of normal flow signal in the dural venous sinuses as described suggests venous sinus thrombosis.
3. Except for stretched left MCA and its Sylvian branches, no significant abnormality is detected on the intracranial MRA on this study.