Name of the Patient : Abc Xyzben lmn / F / 69 yrs.
Referred by : Dr. Abc Xyzhacker.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O vomiting and giddiness since 1 1/2 months.
Known hypertensive and diabetic.
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 coronal images.
5 mm thick T1 Weighted sagittal images.
There are multiple well-circumscribed lesions which are hypointense on the T1 Weighted and T2 Weighted images with a central hyperintensity on the proton and T2 Weighted images within both cerebellar hemispheres, left frontal lobe, left parietal lobe, both temporal lobes and left thalamus. Hyperintense areas are seen on the T1 Weighted images within the lesion in the left cerebellar hemisphere which may represent subacute blood/paramagnetic substances.
These lesions are surrounded by hypointense areas on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and Flair images and would represent perilesional edema. There is indentation upon the fourth ventricle.
There is fullness of the third and both the lateral ventricles.
Irregularly defined areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen within the region of the left petrous bone. Intraluminal signal within the left jugular vein and left transverse and sigmoid sinuses may represent slow flow/thrombus.
There is prominence of the cerebral cortical sulci and Sylvian fissures bilaterally.
Inflammatory changes are noted within the sphenoid sinuses.
The cervical spine was screened with 4 mm thick T2 Weighted sagittal images and shows degenerative changes.
The MRI features are suggestive of :
1. Multiple well-circumscribed lesions within both cerebellar hemispheres, left frontal lobe, left parietal lobe, both temporal lobes and left thalamus and this is not specific for a single diagnosis. The differential diagnosis would include :
b. Infective processes like granulomas/pyaemic abscesses.
2. Areas of altered signal in the left petrous bone may represent inflammatory/neoplastic changes.
A contrast enhanced scan will be worthwhile.