Date : 00.00.00
Name of the Patient : Abc XyzKollmn / M / 74 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O right sided hemiplegia with speech disturbance and loss of bladder/bowel control since 1 1/2 months.
C/O dementia since 4 months.
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 and Gradient sagittal images.
After administration of contrast, the following parameters were used :
5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.
There is a mass lesion in the left high parietal region which measures approximately 3.6 x 2.6 x 2.8 cms. This lesion is hypointense to the white matter on the T1 Weighted images and turns heterogeneously hyperintense on the proton and T2 Weighted images. A central necrotic area is identified within this lesion. There is gross surrounding edema with mass effect and indentation upon the body of the left lateral ventricle with slight inferior displacement. There is slight effacement of the left Sylvian fissure. Extension of the edema is also noted into the corpus callosum.
Hypointense areas are seen on the T1 Weighted images in the periventricular deep white matter in the frontal and parietal regions bilaterally, which turn hyperintense on the proton, T2 Weighted and FLAIR images.
A hyperintense signal on the proton, T2 Weighted and FLAIR images is noted in the left putamen which is seen to be hypointense on the gradient images and would represent calcification. Similar signal change is noted on the Gradient echo images in the right putamen.
After administration of contrast, there is heterogeneous enhancement of the lesion. This lesion appears thick walled. Enhancement is also noted along the meninges in the left fronto-parietal region and the right high parietal and posterior parietal regions. Streaks of enhancement is seen in the left posterior parietal deep white matter. Smaller disc enhancing lesions are also noted in the fronto-parietal regions bilaterally.
There is slight fullness of both the lateral ventricles.
The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.
The MRI features are suggestive of a neoplastic process in both fronto-parietal regions and along the meninges in the left fronto-parietal and right parietal parafalcine region as described. The differential diagnosis may include secondaries or a glial cell tumors like glioblastoma multiforme.
The possibility of these changes being due to granulomatous infective process like tuberculosis seems less likely.