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hs/sb/nl/rg.
/971 Date : 00.00.00

Name of the Patient : Abc Xyzram Kalmn / M / 60 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O difficulty in swallowing since 8-10 days.
Known hypertensive.

EXAMINATION :

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.

NECK MRA IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There are areas of hyperintensity on the proton, T2 Weighted and FLAIR images within the periventricular and fronto-parietal white matter bilaterally, pons and basal ganglia bilaterally. These are iso to hypointense to normal white matter on the T1 Weighted images and are most likely ischemic in etiology.

Lacunar infarcts (iso to hyperintense to CSF) are seen within the basal ganglia bilaterally, pons and right cerebellar hemisphere.

There is mild to moderate dilatation of the ventricular system. Also seen is prominence of the basal cisternal spaces, cerebellar folia and cerebral cortical sulci bilaterally.

There is no shift of the midline structures.

Inflammatory changes are noted in the ethmoidal air cells bilaterally.

INTRACRANIAL MRA :

There is circumferential narrowing of the cavernous segment of the right internal carotid artery.
..2/.







The petrous and supraclinoid segments of the internal carotid arteries bilaterally and the cavernous segment of the left internal carotid artery shows normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, vertebral and posterior cerebral 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.

IMPRESSION :

The MRA features are suggestive of :

1. Areas of altered signal within the periventricular and fronto-parietal white matter bilaterally, pons and basal ganglia bilaterally are most likely ischemic in etiology.

2. Lacunar infarcts within the basal ganglia bilaterally, pons and right cerebellar hemisphere.

3. Mild to moderate dilatation of the ventricular system which is disproportionate to the degree of cerebral atrophy. Normal pressure hydrocephalus should be excluded.

4. Circumferential narrowing of the cavernous segment of the right internal carotid artery.

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