sb/bv/nl/rg.
Date : 00.00.00
Name of the Patient : Abc Xyzankar Achlmn / M / 72 yrs.
Referred by : Dr. Abc Xyzpadia.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
H/O fall on 00.00.00 with loss of consciousness since then. CT Scan s/o intracranial bleed.
Burrhole tapping was done on 00.00.00. For follow up.
Known hypertensive & diabetic. On Rx.
EXAMINATION :
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.
OBSERVATION :
There is seen a fairly large, approximately 5.0 x 4.5 x 6.0 cms sized intermediate signal intensity mass lesion on the T1 Weighted images with its epicentre in the left thalamus. This lesion has a peripheral hyperintense rim on the T1 Weighted images. On the T2 Weighted images, the bulk of the lesion appears relatively hypointense, while the peripheral rim remains hyperintense. There is perilesional edema with effacement of the sulcus spaces in the left temporo-parietal region.
This lesion extends superiorly into the left corona radiata, inferiorly into the subthalamus, midbrain and pons and medially this lesion dissects into the ventricular system with a fluid level in the occipital horns bilaterally. There is indentation upon the left lateral and the third ventricles with mild shift of the midline structures to the right. Both the lateral ventricles appear moderately dilated with periventricular hyperintense signal on the proton, T2 Weighted and FLAIR images suggesting ? periventricular CSF ooze, ?? ischemic changes.
There is seen another approximately, 1.3 x 0.8 x 0.8 cms sized hypointense lesion more pronounced on the proton, T2 Weighted, FLAIR and Fast Scan (T2 *) images in the right cerebellar hemisphere superiorly. This lesion appears iso to hypointense to
the normal white matter on the T1 Weighted images. There is perilesional edema with effacement of the cerebellar folia and mild indentation on the fourth ventricle.
Both these lesions are seen to bloom on the Fast Scan (T2 *) images.
Ill-defined, hyperintense signal on the T1 Weighted images is noted in the left high frontal cortex which remains hyperintense on the proton, T2 Weighted and FLAIR images. A shunt tube is seen to traverse this region into the right lateral ventricle and its tip is seen to lie in the body of the right lateral ventricle.
A burr hole is noted in the left frontal bone. Minimal air is noted in the frontal horn of the right lateral ventricle.
A very small, subdural collection/hematoma is noted in the right
fronto-temporo-parietal region.
A lacunar infarct with perilesional gliotic changes is noted in the right thalamus and right corona radiata.
No obvious vascular anomaly is identified on this study.
Inflammatory changes are noted in the paranasal sinuses and the mastoid air cells.
IMPRESSION :
1. Status post-drainage tube and post-burrhole aspiration.
2. An approximately 5.0 x 4.5 x 6.0 cms sized mass lesion with its epicentre in the left thalamus with extensions as described represents an early subacute hematoma, with extension into the ventricular system.
..3/.
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3. An approximately, 1.3 x 0.8 x 0.8 cms sized lesion in the right cerebellar hemisphere superiorly follows the signal characteristics of an acute right cerebellar hematoma.
4. Altered signal in the left frontal region is the sequelae of previous shunt surgery and burrhole aspiration.
5. A small right fronto-temporo-parietal subdural hematoma/collection.
6. Moderate dilatation of both the lateral ventricles.
As compared to the previous CT Scan dated 00.00.00, the patient is status post-shunt status. There is minimal decrease in the size of lateral ventricles. A new acute hematoma is noted in the right cerebellar hemisphere.