sb/hs/nl/rg.
Name of the Patient : Abc Xyzankar S. Mlmn / M / 74 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O right sided weakness on 00.00.00. CT Scan s/o haemorrhage.
C/O loss of memory for few hours on 00.00.0000.
EXAMINATION :
The brain was screened with 5 mm thick T2 Weighted axial images, 5 mm thick FLAIR coronal images and 5 mm thick T1 Weighted sagittal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
OBSERVATION :
There is a small hyperintense signal on the T1 Weighted images in the left thalamus which remains hyperintense on the T2 Weighted and Flair images and represents a late subacute haemorrhage (extracellular methemoglobin).
There is an ill-defined, hypointense signal on the T1 Weighted images in the subcortical white matter in the left temporal region. This lesion appears hyperintense on the T2 Weighted and Flair images and represents an ischemic lesion.
Lacunar infarcts (iso to hyperintense to CSF) are noted in the left thalamus, right periatrial region and in the lentiform nuclei bilaterally.
There are ill-defined, hypointense areas on the T2 Weighted and Flair images in the periventricular white matter bilaterally and in the left frontal region. These areas also represent ischemic changes.
There is mild to moderate dilatation of both the lateral and third ventricles. The fourth ventricle is normal. There is slight prominence of the cerebral cortical sulci bilaterally.
The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Inflammatory changes are noted in the paranasal sinuses.
An empty sella is also noted.
INTRACRANIAL MRA :
There is slight concentric narrowing of the terminal supraclinoid segment of the left internal carotid artery. The proximal left middle cerebral artery and anterior cerebral artery are however well-identified.
The petrous, cavernous and supraclinoid segments of the right internal carotid artery and the petrous and cavernous segment of the left internal carotid artery show normal signal and calibre. The visualized anterior cerebral, 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 common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
IMPRESSION :
1. Focal altered signal in the left thalamus suggests late subacute haemorrhage (extracellular methemoglobin).
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2. Altered signal in the subcortical white matter in the left temporal region represents an ischemic lesion.
3. Lacunar infarcts in the left thalamus, right periatrial region and in the lentiform nuclei bilaterally.
4. Altered signal in the periventricular white matter bilaterally and in the left frontal region represents ischemic changes.
5. Mild to moderate dilatation of both the lateral and third ventricles.
6. Slight concentric narrowing of the terminal supraclinoid segment of the left internal carotid artery.
7. No other significant abnormality is detected on the intracranial and neck MRA on this study.