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Name of the Patient : Abc Xyza Mazulmn / F / 65 yrs.
Referred by : Dr. Abc Xyzatt.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O dragging of the LLE since 3-4 months with difficulty in swallowing and dysarthria since 2 days.
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.

5 mm thick T1 Weighted sagittal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

BRAIN :

There are hyperintense areas in the pons, periventricular white matter, corona radiata and centrum semiovale bilaterally on the proton, T2 Weighted and FLAIR images. These are hypointense to the white matter on the T1 Weighted images.

Lacunar infarcts (which are iso to hyperintense to CSF on all the pulse sequences) are noted in the thalamus, lentiform nuclei and corona radiata bilaterally.
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There is fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

The A1 segment of the right anterior cerebral artery on the right side is hypoplastic.

The internal carotid artery on the right side has a smaller calibre as compared to the left.

There is slight narrowing and vessel wall irregularity of the M1 segment of the left middle cerebral artery.

The petrous, cavernous and supraclinoid segments of the left internal carotid artery shows normal signal and calibre. The rest of 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.

NECK MRA :

The bifurcation of the common carotid artery on the right side is lower as compared to the left. The right internal carotid artery has a smaller calibre as compared to the left.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of these vessels noted.

IMPRESSION :

1. Altered signal in the pons, periventricular white matter, corona radiata and centrum semiovale bilaterally and would represent areas of ischemia/infarction.
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2. Lacunar infarcts in thalamus, lentiform nuclei and corona radiata bilaterally.

3. Slight narrowing and vessel wall irregularity of the M1 segment of the left middle cerebral artery.

4. The right internal carotid artery has a smaller calibre as compared to the left side.


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