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ke/sb/rg/nl

Name of the Patient : Abc Xyzlmn / F / 70 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O right hemiplegia in May 0000. Detected to have an IC angioma - occluded.
No complaints at present. For follow-up.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images, 5 mm thick Gradient 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 large, ill-defined, hypointense area on the T1 Weighted images in the right parieto-occipital region which is seen to turn hyperintense on the T2 Weighted images. There is resultant dilatation of the occipital horn of the right lateral ventricle and this lesion would represent an area of cystic encephalomalacia. Few areas are seen to bloom on the Gradient images which may represent residual embolic material due to previous embolisation or may represent residual hemosiderin due to previous bleed.

Small hyperintense areas are seen in the right middle cerebellar peduncle, left cerebellar hemisphere and right thalamus which are probably ischemic in etiology.

There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is prominence of the cerebral cortical sulci and cerebellar folia. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.


INTRACRANIAL MRA :

There is slight narrowing of the distal portion of the P2 segment of the right posterior cerebral artery, the distal segment of the right middle cerebral artery and the distal petrous segment of the left internal carotid artery.

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

NECK MRA :

Motion artifacts are noted.

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. An area of cystic encephalomalacia in the right parieto-occipital region as described, most likely is the sequelae of previous embolization of an angioma.

2. Areas of altered signal in the right middle cerebellar peduncle, right thalamus and left cerebellar hemisphere are probably ischemic in etiology.

3. Slight narrowing of the distal portion of the P2 segment of the right posterior cerebral artery, distal right middle cerebral artery and distal petrous segment of the left internal carotid artery.

Previous investigations were not available for comparison.



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