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hs/ke/nl/rg.

Name of the Patient : Abc Xyzv lmn / M / 70 yrs.
Referred by : Dr. Abc Xyzdikhaye.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches, giddiness and pain in the chest.

EXAMINATION :

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.

5 mm thick T1 Weighted sagittal images.

SOME IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There is evidence of an irregularly defined area of hyperintensity with a few hypointense areas on the T1 Weighted images within the cerebellar vermis and extending into both cerebellar hemispheres. These are seen to remain hyperintense on the T2 Weighted images with a few areas turning hypointense, especially on the Fast Scan (T2 *) images. These areas would represent subacute blood. This lesion is seen to compress upon the fourth ventricle.

Diffuse areas of hyperintensity on the proton, T2 Weighted and FLAIR images are noted within the periventricular white matter bilaterally. These are iso to hypointense to white matter on the T1 Weighted images and are most likely ischemic in etiology. Smaller areas with similar signal characteristics are noted within the pons and left lentiform nucleus.



Lacunar infarcts (iso to hyperintense to CSF) is noted within the right corona radiata and extending into the right lentiform nucleus. Adjacent to this are areas of hyperintensity on the proton, T2 Weighted and FLAIR images and which may represent gliotic changes. There is ex-vacuo dilatation of the right lateral ventricle.

There is fullness of the third and both the lateral ventricles.

Note is made of a hyperintense signal on all the pulse sequences within the sigmoid and transverse sinuses on the left side and this may represent slow flow/thrombus.

There is slight prominence of the cerebral cortical sulci, especially in the left parietal region.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

IMPRESSION :

1. A space-occupying lesion within the cerebellar vermis with presence of subacute blood as described. This lesion may represent a haemorrhagic venous infarct or a tumor with a bleed. A follow up scan may be worthwhile.

2. Lacunar infarcts within the right corona radiata and extending into the right lentiform nucleus.

3. Diffuse areas of altered signal within the periventricular white matter bilaterally, within the pons and left lentiform nucleus are most likely ischemic in etiology.



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