Date : 00.00.00
Name of the Patient : Abc Xyz Shelmn / M / 40 yrs.
Referred by : Dr. Abc Xyzbar.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O gait ataxia with speech disturbances since 15 days.
Also C/O tingling in BUE and BLE since 2 years.
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.
There are fairly well-defined areas which are near isointense to CSF on all the pulse sequences within the right temporo-parieto-occipital lobes. Adjacent to these are areas which are hypointense on the T1 Weighted images and which turn hyperintense on the Proton, T2 Weighted and FLAIR images and would represent gliotic changes. These lesions in toto would represent an area of cystic encephalomalacia. A similar smaller lesion is noted in the right cerebellar hemisphere.
Irregularly defined areas of hyperintensity on the proton, T2 Weighted and FLAIR images are noted within the periventricular white matter, right middle cerebellar peduncle, pons and the white matter in the fronto-parietal lobes bilaterally. These are iso to hypointense to normal white matter on the T1 Weighted images and are most likely ischemic in etiology.
Lacunar infarcts (iso to hyperintense to CSF) are seen within the right centrum semiovale, pons and the lentiform nuclei and thalamus bilaterally.
There is prominence of the basal cisternal spaces, cerebral cortical sulci and cerebellar folia bilaterally.
There is slight fullness of the third and both the lateral ventricles. The fourth ventricle is normal.
There appears to be slow flow within the left internal jugular vein and the left sigmoid and transverse sinuses.
There is no shift of the midline structures.
Inflammatory changes are noted within both the maxillary sinuses.
The MRI features are suggestive of :
1. Areas of cystic encephalomalacia within the right temporo-parieto-occipital lobes and in the right cerebellar hemisphere.
2. Areas of altered signal intensity within the periventricular white matter, right middle cerebellar peduncle, pons and the white matter in the fronto-parietal lobes bilaterally are
most likely ischemic in etiology.
3. Lacunar infarcts within the right centrum semiovale, pons and the lentiform nuclei and thalamus bilaterally.
4. Cerebral and cerebellar atrophy.