Date : 00.00.00
Name of the Patient : Abc Xyz Mlmn / M / 66 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O intracerebral hematoma for which tapping was done.
Patient remains drowsy post-operatively with level of consciousness being out of proportion to his left hemiparesis.
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.
IMAGES SHOW PATIENT MOTION.
There is evidence of craniectomy on the right side in the right temporal region with post-operative changes in the soft tissues.
There is evidence of a lesion in the region of the right lentiform nucleus extending into the right temporal lobe. This lesion has a hyperintense rim on all the pulse sequences with a hypointense centre and is suggestive of subacute blood (extracellular methemoglobin) in an evolving hematoma. There is surrounding edema and mass effect with compression of the body and frontal horn of the right lateral ventricle, effacement of the sulci in the right fronto-temporal region and effacement of the Sylvian cistern and perimesencephalic cistern on the right side. Fluid-fluid levels are seen within the occipital horns of both the lateral ventricles and this would suggest intraventricular extension of the bleed.
Hyperintense foci are seen on the proton, T2 Weighted and FLAIR images in the thalami bilaterally, left lentiform nucleus, periventricular white matter bilaterally and left corona radiata and these probably represent ischemic changes.
A lacunar infarct (iso to hyperintense to CSF) is noted in the left thalamus.
There is a hypointense area on the T2 Weighted images located in the left external capsule and the left basal ganglia which is seen to bloom on the Fast Scan (T2 *) images and probably represents paramagnetic substances/hemosiderin.
The left lateral ventricle shows fullness. The fourth ventricle is normal. The remaining basal cisternal spaces are prominent. No obvious vascular anomaly is identified on this study.
1. Post-operative status.
2. A subacute hematoma in the right lentiform nucleus extending into the right temporal lobe with mass effect as described.
As compared to the previous MRI (study no:00006) dated September 6, 0000, the hematoma appears smaller in size. However the surrounding edema has increased. Also seen is extension of this bleed into the ventricular system.