Date : 00.00.00
Name of the Patient : Abc Xyzan A. Kattulmn / M / 62 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O headaches with difficulty in swallowing solids and decreased hearing on the left side.
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.
MR cisternogram was obtained in the coronal plane.
5 mm thick T1 Weighted sagittal images.
There is seen an ill-marginated, fairly large, intermediate signal intensity mass lesion on the T1 Weighted images in the posterior nasopharyngeal wall. This lesion appears heterogeneously hyperintense on the proton and T2 Weighted images. Subtle signal change of the clivus is noted in this region. There is involvement of the longus capitus muscles as also the fossa of Rosenmuller, with effacement of the pharyngo tympanic tubes. Extension of the lesion around the carotid canals at the skull base is noted, bilaterally, with probable involvement of the left petrous tip. There is however, no extension of the lesion into the cavernous sinuses on either side. No definite evidence of involvement of the pterygoid muscles is noted. No obvious intracranial extensions of the lesion is also noted.
Lacunar infarcts are noted in the right lentiform nucleus, bilateral thalami and in the right centrum semiovale.
Small bright foci on the proton and T2 Weighted images in the posterior parietal periventricular white matter bilaterally and in the frontal deep white matter bilaterally most likely represent ischemic changes.
The seventh and eighth cranial nerve complex appears unremarkable on either side.
There is mild dilatation of both the lateral and third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulci and the basal cisternal spaces bilaterally. There is no shift of the midline structures.
Inflammatory changes are noted in the ethmoidal and mastoid air cells and in the maxillary and sphenoid sinuses.
1. Fairly large mass lesion in the posterior nasopharyngeal wall with extensions and signal characteristics as described is not specific for a single etiology. This most likely represents a nasopharyngeal carcinoma.
2. Lacunar infarcts in the right lentiform nucleus, bilateral thalami and in the right centrum semiovale.
3. Areas of ischemia in the posterior parietal periventricular white matter bilaterally and in the frontal deep white matter bilaterally.
A contrast enhanced scan would be worthwhile.