Name of the Patient : Abc Xyz lmn / M / 47 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
Alleged H/O train accident on 00.00.0000 with loss of consciousness for 3 days.
Now Patient is in subconscious state.
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 and Fast Scan (T2 *) coronal images.
There are ill-defined, hypointense areas on the T1 Weighted images in the right frontal and right anterior temporal lobe. These are seen to turn hyperintense on the proton, T2 Weighted, FLAIR and the Gradient images. Few hyperintense areas are also noted within the lesion on the T1 Weighted images which are seen to turn hypointense on the proton, T2 Weighted and FLAIR images and seen to bloom on the Gradient images and represents haemorrhage (intracellular methaemoglobin). There is mass effect with effacement of the adjacent sulci. This would represent areas of haemorrhagic contusion.
A small hypointense signal is seen in the genu of the internal capsule on the left side on the T1 Weighted images and is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images and may represent diffuse axonal injury.
The sulcal spaces in the posterior parietal region bilaterally and right Sylvian area show intermediate signal intensity on the T1 Weighted images and which turn hyperintense on the proton, T2 Weighted and FLAIR images and would represent subarachnoid haemorrhage.
- 2 - Scan-00009
A small subdural (extracerebral) collection which is hyperintense on the T2 Weighted images is seen in the right anterior temporal region and represents subdural hematoma.
A small extra-axial (most likely epidural) collection is seen in the posterior fossa under the left cerebellar hemisphere.
Subdural collections are also noted in the frontal lobes bilaterally (left more than right) which is isointense to CSF on all pulse sequences and would represent subdural effusion. There is some mass effect on the left side on the underlying brain parenchyma.
Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
The suspected left occipital fracture seen on CT Scan is not well-identified on this study.
The MRI features are suggestive of :
1. Haemorrhagic contusion in the right frontal and right anterior temporal lobes with mass effect.
2. Altered signal in the genu of the internal capsule on the left side may represent diffuse axonal injury.
3. Subarachnoid haemorrhage in the posterior parietal region bilaterally and right Sylvian region.
4. A small (extracerebral) subdural hematoma in the right anterior temporal region.
5. Subdural collection in the frontal lobe bilaterally
would represent subdural effusions.
6. Extra-axial (most likely epidural) collection located under the left cerebellar hemisphere.