Name of the Patient : Abc Xyzna Klmn / F / 18 yrs.
Referred by : Dr. Abc Xyzarucha.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O headaches with papilledema.
H/O left sided diplopia with 6th nerve palsy.
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.
3 mm thick T2 Weighted coronal images.
After administration of contrast the following parameters were used :
5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.
There are atleast two conglomerate lesions which are hypointense on the proton, T2 Weighted and Flair images within the left frontal lobe. These are not well-defined on the T1 Weighted images. These lesions are surrounded by white matter edema (hypointense on the T1 Weighted images and hyperintense on the proton, T2 Weighted and Flair images) in the left fronto-temporal lobes with effacement of the adjacent sulci and indentation upon the third and the left lateral ventricles. There is a slight shift of the midline to the right. Also seen is mild dilatation of the right lateral ventricle (including the right temporal horn). There is slight extension of this white matter edema into the posterior limb of the left internal capsule.
There is mild prominence of the cerebellar folia bilaterally. Also seen is mild fullness of the fourth ventricle.
The basal cisternal spaces are unremarkable. No obvious vascular anomaly is identified on this study.
After administration of contrast, the aforementioned lesions show thick and intense peripheral ring enhancement.
The MRI features are suggestive of atleast two conglomerate
lesions within the left frontal lobe with mass effect, edema and enhancement pattern as described. These most likely represent granulomas and are seen to follow the signal characteristics of tuberculomas.