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ke/sb/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Mirlmn / F / 61 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Old C/O cavernous sinus thrombosis with right eye proptosis and visual loss on the right side and diminished vision of the left eye since February 0000.
H/O Embolization of CCF in May 0000.
Now C/O left hemiplegia with altered sensorium and generalized rigidity of all 4 limbs since then.

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.
3 thick T1 Weighted and STIR coronal images.
5 mm thick T1 Weighted sagittal images.
FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the periventricular deep white matter bilaterally. These are iso to hypointense to normal white matter on the T1 Weighted images and may represent ischemic changes.

Lacunar infarcts are noted in the right lentiform nucleus and bilateral centrum semiovale.

The optic nerves on either side show normal signal intensity bilaterally.



There is moderate dilatation of the ventricular system. There is a hypointense signal more pronounced on the T2 Weighted images
within the superior portion of the fourth ventricle, aqueduct and the third ventricle which may suggest increased CSF flow. There is slight prominence of the cerebral cortical sulci and cerebellar folia bilaterally. Prominence of the basal cisternal spaces is also noted. There is no shift of the midline structures. Slight ectasia of the vertebro-basilar system is seen.

Ill-defined, hyperintense signal on the STIR images are noted in the retro-orbital fat on the right, which may suggest inflammatory changes, in the given clinical setting.

Inflammatory changes are noted in the mastoid air cells bilaterally.

The cavernous sinuses are unremarkable on either side, on this study.

IMPRESSION :

1. Altered signal in the periventricular deep white matter bilaterally may suggest ischemic changes (less likely to represent transependymal CSF seepage).

2. Lacunar infarcts in the right lentiform nucleus and bilateral centrum semiovale.

3. Moderate dilatation of the ventricular system is disproportionate to the degree of the cerebral atrophy and this can be seen with normal pressure hydrocephalus.

4. Bilateral mastoiditis.

5. Altered signal in the retro-orbital fat on the right may suggest inflammatory changes.

The previous investigations were not available for review/comparison.
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