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Name of the Patient : Abc XyzV. Balmn / M / 64 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided hemiparesis on 00.00.0000 from which patient has partially recovered.
Known hypertensive/diabetic.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick FLAIR coronal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

SOME IMAGES SHOW PATIENT MOTION.

OBSERVATION :

A hyperintense area on the FLAIR images is seen within the right insular cortex and this may be ischemic in etiology.

Lacunar infarcts (iso to hyperintense to CSF) are noted in the right lentiform nucleus.

Small bright foci on the T2 Weighted and FLAIR images in the deep white matter in the left frontal region may represent ischemic changes.

There is mild 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 maxillary sinuses bilaterally.
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- 2 - Scan-00001/00003


INTRACRANIAL MRA :

There is concentric narrowing of the mid-portion of the M1 segment of the left middle cerebral artery. The posterior cerebral arteries appear slightly irregular bilaterally. The left posterior cerebral artery appears as a continuation of the left posterior communicating artery.

A persistent bright signal in the midsegment of the A1 segment of the left anterior cerebral artery is of ? etiology (?? aneurysm).

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

NECK MRA :

Motion artifacts are noted.

There is significant stenosis of the proximal 2.0 cms of the right internal carotid artery from its origin.

An atherosclerotic plaque is seen along the postero-medial wall of the terminal left common carotid artery extending into the left external carotid artery.

Narrowing of origin of the left internal carotid artery of its proximal 1.5 cms segment is also noted.

IMPRESSION :

1. Areas of altered signal intensity in the right insular cortex may be ischemic in etiology.

2. Lacunar infarcts in the right lentiform nucleus.
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- 3 - Scan-00001/00003


2. Small bright foci on the T2 Weighted and FLAIR images in the deep white matter in the left frontal region may represent ischemic changes.

3. Concentric narrowing of the midsegment of the M1 segment of the left middle cerebral artery and slight irregularity of the posterior cerebral arteries may be due to atherosclerotic changes.

4. A persistent bright signal in the midsegment of the A1 segment of the left anterior cerebral artery is of ? etiology (?? aneurysm).

5. Significant stenosis of the proximal 2.0 cms of the right internal carotid artery from its origin.

6. An atherosclerotic plaque along the postero-medial wall of the terminal left common carotid artery extending into the left external carotid artery.

7. Significant narrowing of origin of the left internal carotid artery of its proximal 1.5 cms segment.




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