Date : 00.00.00
Name of the Patient : Abc Xyzbhai G. lmn / M / 59 yrs.
Referred by : Dr. Abc Xyzndel.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O drooping of the left eyelid with numbness over the left half of the face and speech disturbance since 1 month.
The brain was screened with 5 mm thick T2 Weighted axial images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
MOTION ARTIFACTS ARE NOTED IN SOME IMAGES.
There are ill-defined, hyperintense areas on the T2 Weighted images in the parathird ventricular regions bilaterally extending into the thalami. Similar signal intensity lesion is noted in the left medial temporal region and in the left cerebral peduncle, near the midline. These lesions most likely represent ischemic lesions.
There is mild fullness of both the lateral and the third ventricles. 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 maxillary sinuses bilaterally.
INTRACRANIAL MRA :
The right vertebral artery and the A1 segment of the right anterior cerebral artery appear hypoplastic. Narrowing of the terminal right vertebral artery, left posterior cerebral artery and distal left middle cerebral artery is noted.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized left anterior cerebral, right middle cerebral, basilar, left vertebral and right 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 is 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. Altered signal in the parathird ventricular regions bilaterally extending into the thalami and in the left medial temporal region and left cerebral peduncle, near the midline, most likely represent ischemic changes.
2. Narrowing of the terminal right vertebral artery, left posterior cerebral artery and distal left middle cerebral artery may be due to atherosclerotic changes.