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Name of the Patient : Abc Xyzlata L. Plmn / F / 60 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left hemiparesis since 00.00.0000.
Known hypertensive.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial 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 images along the cortex and the subcortical white matter in the right fronto-temporo-parietal region. This lesion appears hypointense to the normal white matter on the T1 Weighted images and represents a recent ischemic lesion. Resultant effacement of the cortical sulcal spaces is noted in that region.

A lacunar infarct is noted in the left frontal deep white matter.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

There is concentric narrowing of the supraclinoid segment of the left internal carotid artery.





The petrous and cavernous segments of the right internal carotid artery appear smaller in calibre as compared to the left. There is a complete cut-off at the midsegment of the right middle cerebral artery with faint visualization of some of its Sylvian branches. Slight narrowing of the terminal left middle cerebral artery is also noted. Its Sylvian branches are however well-identified.

The right posterior cerebral artery appears as a continuation of the right posterior communicating artery. The right vertebral artery is hypoplastic.

The petrous and cavernous segments of the left internal carotid artery show normal signal and calibre. The visualized anterior cerebral, basilar, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The left common carotid artery and its bifurcation and the left vertebral artery appears normal. The right vertebral artery is hypoplastic.

There is significant narrowing of the terminal right common carotid artery and the proximal right internal carotid artery with a plaque along the posterior wall of the proximal right internal carotid artery. Resultant severe stenosis of the proximal right internal carotid artery is noted.

IMPRESSION :

1. Altered signal along the cortex and the subcortical white matter in the right fronto-temporo-parietal region
represents a recent ischemic lesion.

2. A lacunar infarct in the left frontal deep white matter.

3. Complete cut-off at the midsegment of the right middle cerebral artery may suggest an embolic lesion.
..3/.





- 3 - Scan-00008


4. Slight narrowing of the terminal left middle cerebral artery may be due to atherosclerotic changes.

5. Hypoplastic right vertebral artery.

6. Smaller calibre of the petrous and cavernous segments of the right internal carotid artery.

7. Significant narrowing of the terminal right common carotid artery and the proximal right internal carotid artery with a plaque along the posterior wall of the proximal right internal carotid artery and resultant severe stenosis of the proximal right internal carotid artery.





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