sb/ke/nl/nl
Date : 00.00.00
Name of the Patient : Abc Xyzkant Trilmn / M / 75 yrs.
Referred by : Dr. Abc Xyz Sampat.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O weakness of the LLE since 2 years.
Known hypertensive/diabetic.
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.
OBSERVATION :
There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the subcortical white matter in the right temporal, occipital lobes and frontal lobes, in the pons and in the periventricular white matter bilaterally. These lesions appear hypointense to normal white matter on the T1 Weighted images.
Lacunar infarcts are noted in the right frontal deep white matter, right lentiform nucleus, bilateral thalami and in the cerebellar hemispheres bilaterally.
There is mild to moderate dilatation of the ventricular system which is disproportionate to the degree of cerebral cortical atrophy. There is prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally.
There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
Scan-00002
Inflammatory changes are noted in the left maxillary antrum.
Partial fusion of C2/C3 vertebrae is noted.
IMPRESSION :
1. Altered signal in the subcortical white matter in the right temporal, occipital lobes and frontal lobes in the pons and in the periventricular white matter bilaterally most likely represent ischemic changes.
2. Lacunar infarcts in the right frontal deep white matter, right lentiform nucleus, bilateral thalami and in the cerebellar hemispheres bilaterally.
3. Mild to moderate dilatation of the ventricular system which is disproportionate to the degree of cerebral cortical atrophy. Normal pressure hydrocephalus should be ruled out.
As compared to the previous CT Scan dated 00.00.00, there is no significant change in the size of the ventricles.