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sb/hs/rg.
Date : 00.00.00

Name of the Patient : Abc XyzKhalifa Slmn / M / 60 yrs.
Referred by : Dr. Abc Xyzlpani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O left sided hemiparesis with slurred speech and LOC for 8 days, 3 months ago.
Alleged H/O fall with injury to forehead 1 month back.
Known 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 and Fast Scan (T2 *) coronal images.

OBSERVATION :

There are CSF intensity lesions on all the pulse sequences in the right fronto-temporo-parietal region (along the watershed zone of the right middle cerebral artery with the right anterior cerebral and right posterior cerebral arteries). Perilesional white matter hyperintense signal on the proton, T2 Weighted and FLAIR images would represent gliotic changes. These lesions represent areas of cystic encephalomalacia, most likely the sequelae of a previous vascular insult. Involvement of the right sided caudate and lentiform nuclei is also noted.

There are ill-defined, hyperintense areas on the T2 Weighted and FLAIR images in the left cerebellar hemisphere, pons, periventricular white matter on the left and in the left centrum semiovale. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images and most likely represent ischemic changes. There is mild dilatation of both the lateral (right more than left) and the fourth ventricles. There is mild fullness of the third ventricle.


There is prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Inflammatory changes are noted in the paranasal sinuses.

IMPRESSION :

The MRI features are suggestive of :

1. Areas of cystic encephalomalacia in the right fronto-temporo-parietal region (along the watershed zone of the right middle cerebral artery with the right anterior cerebral and posterior cerebral arteries) are most likely the sequelae of a previous vascular insult.

2. Altered signal in the left cerebellar hemisphere, pons, periventricular white matter on the left and in the left centrum semiovale most likely represent ischemic changes.
3. Mild cerebral cortical and cerebellar atrophy.


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