Name of the Patient : Abc Xyzd O. lmn / M / 69 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O gait imbalance since 2 months.
H/O tingling in the LUE in September 0000 which subsequently recovered.
The brain was screened with 5 mm thick T2 Weighted axial images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
There is no focal area of altered signal intensity within the brain parenchyma.
There is slight fullness of the third and both the lateral ventricles. The fourth ventricle is normal. There is mild prominence of the cerebral cortical sulci bilaterally.
The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
INTRACRANIAL MRA :
The cavernous and supraclinoid segments of the internal carotid artery on the right side appears smaller in calibre (concentric narrowing).
The left middle cerebral artery, distally is irregular and shows attenuation of the flow signal. There is a paucity of the Sylvian vessels on the left side.
Slight flow signal is seen in the distal left vertebral artery (? retrograde flow).
The A1 segment of the right anterior cerebral artery is hypoplastic.
The petrous segment of the internal carotid arteries bilaterally and the cavernous and supraclinoid segments of the left internal carotid artery show normal signal and calibre. The visualized left anterior cerebral, right middle cerebral, basilar, right vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The left vertebral artery is not visualized along its entire course in the neck (? stenosed at origin ? dissection).
The common carotid arteries and their extracranial branches appear normal bilaterally.
1. Concentric narrowing of the cavernous and supraclinoid segments of the right internal carotid artery.
2. Flow attenuation and irregularity of the left middle cerebral artery and a paucity of the Sylvian vessels on the left side.
3. Non-visualization of the left vertebral artery (? stenosed at origin ? dissection).