Date : 00.00.00
Name of the Patient : Abc Xyzani lmn / F / 33 yrs.
Referred by : Dr. Abc Xyzagwati / Dr. Abc Xyztil.
Examination : M.R.I. of the Brain & Orbits.
CLINICAL PROFILE :
H/O diplopia on the left side since 1 month with pain and loss of vision since 8 days.
C/O numbness on the left side of the face.
M.R.I of the brain & orbits was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
5 mm thick FLAIR coronal images.
3 mm thick T1 Weighted and STIR coronal images.
After administration of contrast the following parameters were used :
5 mm thick T1 Weighted axial images with magnetization transfer.
3 mm thick T1 Weighted coronal and axial images with fat saturation.
5 mm thick T1 Weighted oblique sagittal images with fat saturation.
There is no focal area of abnormal signal intensity within the brain parenchyma.
Ill-defined hypointense signal on the T1 Weighted images which turns heterogeneously hyperintense on the T2 Weighted images is seen within the superior orbital fissure bilaterally, left more than right (se/im. 106.7/8). The lesion on the left side is also seen to involve the left orbital apex and cannot be seperated from the left optic nerve.
After administration of contrast, there is fairly homogeneous enhancement of the lesion in the left superior orbital fissure and subtle peripheral enhancement of the lesion in the right superior orbital fissure.
Both the lateral, third and the fourth ventricles show fullness.
There is mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
Incidental note is made of bilateral maxillary sinusitis and inflammatory changes in the ethmoidal air cells and a Thornwaldts cyst.
The MRI features are suggestive of areas of altered signal intensity within the superior orbital fissures bilaterally, left more than right with enhancement pattern as described and this is not specific for a single diagnosis. Inflammatory lesion like a pseudotumor may be considered (? sarcoidosis, ? granulomatous lesions). This is less likely to represent a neoplastic process.
As compared to the preivous MRI (study no:00007) dated 00.00.00 :
1. The lesion in the right superior orbital fissure is unchanged.
2. A new lesion is seen in the left superior orbital fissure and left orbital apex.