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ke/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzben lmn / F / 71 yrs.
Referred by : Dr. Abc Xyzauhan.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left hemiplegia since 3 months.
Known hypertensive. On Rx.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial and Fast Scan (T2 *) coronal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

Neck MRA images show patient motion.

OBSERVATION :

There are hyperintense areas on the T2 Weighted and Fast Scan (T2 *) images involving the cortex and the subcortical white matter in the right temporo-parietal region, right lentiform nucleus and the right corona radiata. These are hypointense to white matter on the T1 Weighted images with a few hyperintense areas and these may represent haemorrhagic infarcts.

Hyperintense areas on the T2 Weighted images is seen in the left corona radiata, pons and the right cerebral peduncle. These are most likely ischemic in etiology.

A lacunar infarct (isointense to CSF on all the pulse sequences) is seen in the left parathird ventricular region and the left centrum semiovale.

There is mild fullness of both the lateral, third and the fourth ventricles with slight prominence of the cerebral cortical sulci and cerebellar folia. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.


INTRACRANIAL MRA :

There is narrowing of the mid-portion of the M1 segment of the right middle cerebral artery with slight paucity of the vessels in the right Sylvian area. Also seen is very mild narrowing of the distal aspect of the M1 segment of the left middle cerebral artery.

The right vertebral artery is hypoplastic.

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior 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 :

There is irregularity of the common carotid artery just prior to its bifurcation. Irregularity and narrowing of the right external carotid artery at the level of its origin and of its proximal segment is also seen.

Slight vessel wall irregularity of the right internal carotid artery at its origin is seen.

The right vertebral artery is hypoplastic.

IMPRESSION :

The MRA features are suggestive of :

1. Haemorrhagic infarcts along the cortex and the subcortical white matter in the right temporo-parietal region, right lentiform nucleus and the right corona radiata.
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2. Areas of altered signal in the left corona radiata, pons and the right cerebral peduncle are most likely ischemic in etiology.

3. A lacunar infarct in the left parathird ventricular region and the left centrum semiovale.

4. Narrowing of the mid-portion of the M1 segment of the right middle cerebral artery with paucity of the vessels in the right Sylvian area. Also seen is very mild narrowing of the distal aspect of the M1 segment of the left middle cerebral artery.

5. Irregularity of the common carotid artery just prior to its bifurcation with irregularity of the right external carotid artery at the level of its origin and of its proximal segment. Also seen is irregularity and narrowing of the right internal carotid artery at its origin.



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