/593 Date : 00.00.00
Name of the Patient : Abc XyzBhlmn / M / 72 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O gait ataxia, giddiness and heaviness of head since 1 year.
H/O similar complaints 8-9 years ago.
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.
A wedge shaped area which is isointense to CSF is seen in the right cerebellar hemisphere and would represent a lacunar infarct.
There are lacunar infarcts (isointense to CSF on all the pulse sequences) in the left cerebellar hemisphere, pons and bilateral cerberal peduncles and corona radiata.
There is slight fullness of both the lateral, third and fourth ventricles. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally.
The basal cisternal spaces are slightly prominent. There is no shift of the midline structures.
Incidental note is made of bilateral maxillary polyps and inflammatory changes in the posterior ethmoidal air cells on the right side.
INTRACRANIAL MRA :
There is narrowing of the proximal portion of the M1 segment of the left middle cerebral artery. Also seen is slight narrowing of the proximal portion of the A2 segment of the right anterior cerebral artery.
A short segment over which the normal flow is not seen is noted within the basilar artery just prior to its bifurcation. There is flow attenuation of the distal posterior cerebral arteries bilaterally.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized left anterior cerebral, right middle cerebral and vertebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
The MRA features are suggestive of :
1. An old infarct within the right cerebellar hemisphere.
2. Lacunar infarcts in the left cerebellar hemisphere, pons and bilateral cerberal peduncles and corona radiata.
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3. Cerebral and cerebellar atrophy.
4. Narrowing of the proximal portion of the M1 segment of the left middle cerebral artery and slight narrowing of the proximal portion of the A2 segment of the right anterior cerebral artery.
5. Marked flow signal attenuation within the basilar artery just prior to its bifurcation.
6. Flow signal attenuation of the distal posterior cerebral arteries bilaterally.