sb/ke/nl/nl
/412 Date : 17/00.00.00
Name of the Patient : Abc Xyzeep Ralmn / M / 13 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
Alleged H/O being hit by a bat on the left side of head on 00.00.00.
C/O right sided hemiparesis since 00.00.00.
EXAMINATION :
The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick Flair and Fast Scan (T2 *) coronal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
OBSERVATION :
There is an ill-defined, hyperintense signal on the T2 Weighted, Flair and Fast Scan (T2 *) images along the cortex and subcortical white matter in the left fronto-temporo-parietal region and in the left lentiform nucleus and head of the left caudate nucleus. This lesion appears hypointense on the T1 Weighted images. There is resultant effacement of the sulcal spaces, compression of the left lateral and third ventricles and the left cerebral peduncle and mild shift of the midline structures to the right. Patchy hyperintense signal on the T1 Weighted images in the left lentiform nucleus and the cerebral cortex in the left parietal region may represent early subacute hemorrhage.
The right lateral and the fourth ventricles are normal. The basal cisternal spaces are unremarkable.
INTRACRANIAL MRA :
There is non-visualization of the intracranial segment of the left internal carotid artery and its branches. The left anterior cerebral artery is visualized though the A1 segment of the left anterior cerebral artery is ? hypoplastic.
The petrous, cavernous and supraclinoid segments of the right internal carotid artery show normal signal and calibre. The visualized right anterior cerebral, right 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 source images reveal normal calibre of the vertebral arteries bilaterally and the right common carotid artery and the proximal right internal and external carotid arteries.
The left common carotid artery appears smaller in calibre when compared to the right. The left internal carotid artery is faintly visualized in the neck. The left external carotid artery also shows an attenuated size and signal characteristics on this study.
IMPRESSION :
The MRI features suggest a fairly large, recent infarct in the territory of the left middle cerebral artery circulation, with evidence of patchy early subacute haemorrhage and mass effect as described.
The MR angio reveals non-visualization of the intracranial segment of the left internal carotid artery and a faintly visualized left common carotid artery in the neck. The proximal segment of the left internal carotid artery is faintly visualized. The vertebral arteries, right carotid circulation and the left anterior and posterior cerebral arteries are well identified.