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Name of the Patient : Abc Xyzp Salulmn / M / 33 yrs.
Referred by : Dr. Abc Xyzthi.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O blackouts with paresthesias in the LUE.

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 an ill-defined, hyperintense signal on the T2 Weighted images along the cortex and subcortical white matter in the right temporo-parietal and posterior parietal region. This lesion appears predominantly hypointense on the T1 Weighted images and represents a recent ischemic lesion. Ill-defined, hyperintense signal on the T1 Weighted images, scattered in this lesion would represent acute to subacute petechial haemorrhage. There is resultant sulcal space effacement and minimal indentation and anterior displacement of the atrium of the right lateral ventricle. Ischemic foci are also noted in the watershed of the right anterior cerebral artery and right middle cerebral artery.

The left lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is prominence of the cerebellar folia bilaterally. There is no shift of the midline structures.

INTRACRANIAL MRA :

There is slight crowding with anterior displacement of the Sylvian branches of the right middle cerebral artery, which are otherwise unremarkable. The right middle cerebral artery is otherwise unremarkable.
..2/.







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

NECK MRA :

The common carotid arteries and their bifurcations and the right vertebral artery are unremarkable. Defects in the common carotid artery and the internal carotid artery at the level of the bifurcation on the left side is artifactual.

The left vertebral artery has an anamolous origin from the arch of tha aorta, between the left common carotid artery and the left subclavian artery. The left vertebral artery is otherwise unremarkable.

IMPRESSION :

1. Altered signal in the right temporo-parietal and posterior parietal region as described represents a recent ischemic lesion with petechial haemorrhage within.

2. Crowding and anterior displacement of the Sylvian branches of the right middle cerebral artery due to the ischemic lesion.

3. Anamolous origin of the left vertebral artery from the aortic arch.

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