ke/sb/nl/rg.

Name of the Patient : Abc Xyzndra Y. Jalmn / M / 55 yrs.
Referred by : Dr. Abc Xyzmat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O forgetfullness.

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 a large, ill-defined, hyperintense area on the T1 Weighted images in the left temporo-occipital region involving the grey and white matter. This is hypointense to normal white matter on the T1 Weighted images and would represent an area of recent infarct.

Lacunar infarcts are seen in the head of the left caudate nucleus, bilateral thalami, corona radiata and left lentiform nucleus.

Ill-defined, hyperintense areas on the T2 Weighted images in the periventricular deep white matter are ischemic in etiology.

There is moderate dilatation of both the lateral and third ventricles.

The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is prominence of the cerebellar folia bilaterally. There is no shift of the midline structures.

Incidental note is made of mild inflammatory changes in the maxillary sinuses and ethmoidal air cells.


INTRACRANIAL MRA :

There is narrowing of the distal portion of the P2 segment of the left posterior cerebral artery.

The cavernous segment of the right internal carotid artery is narrow.

The right posterior communicating artery is seen as a continuation of the posterior cerebral artery.

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

NECK MRA :

There are filling defects in the internal carotid arteries bilaterally, at the level of the common carotid bifurcations, which most likely represent flow related artifacts.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

The left vertebral artery has a dural origin.

IMPRESSION :

1. A recent infarct in the left temporo-occipital region, involving the grey and white matter.

2. Lacunar infarcts in the head of the left caudate nucleus, bilateral thalami, corona radiata and left lentiform nucleus.
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3. Altered signal in the periventricular deep white matter is ischemic in etiology.

4. Moderate dilatation of both the lateral and third ventricles.

5. Narrowing of the distal portion of the P2 segment of the left posterior cerebral artery.

6. Narrowing of the cavernous portion of the right internal carotid artery.

7. Filling defects in the internal carotid arteries bilaterally at the level of the common carotid bifurcation represents
flow related artifacts.