Date : 00.00.00
Name of the Patient : Abc Xyz Mazgaolmn / F / 38 yrs.
Referred by : Dr. Abc Xyzhatt / Dr. Abc Xyzhta.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O disorientation with subconsciousness since 3-4 days.
Patient is HIV +ve and is on AKT.
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.
There are hypointense areas on the T1 Weighted images in the right frontal region, left lentiform nucleus, right paraventricular region, left temporal region, thalamus and both parietal regions. These are seen to remain hypointense on the proton, T2 Weighted and FLAIR images. Hyperintense areas are seen at the periphery of few of these lesions on T1 Weighted images which are seen to remain so on the proton, T2 Weighted and FLAIR images and may represent extracellular methaemoglobin/paramagnetic substances. There is surrounding edema with mass effect and effacement of the adjacent sulci.
Hyperintense areas are seen in the white matter in the cerebral hemispheres bilaterally and the splenium of the corpus callosum on the T2 Weighted and FLAIR images. This may suggest progressive multifocal leucoencephalopathy or HIV encephalitis.
There is slight prominence of the cerebellar folia bilaterally.
Both the lateral and the third ventricles show mild fullness.
The fourth ventricle is normal. The basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.
Incidental note is made of inflammatory changes in the sphenoid sinus and the mastoid air cells.
The MRI features are suggestive of altered signal in the right frontal region, left lentiform nucleus, right paraventricular region, left temporal region, in the posterior high parietal region bilaterally and the left thalamus with mass effect and edema and these may represent a granulomatous infective process like toxoplasmosis.
As compared to the previous MRI (study No.00002) dated 00.00.00, there is,
1. The lesions are unchanged in size and number although there is reduction in the edema and mass effect.
2. White matter changes seen in both cerebral hemispheres may reflect PML or HIV encephalitis.