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Name of the Patient : Abc Xyzee lmn / F / 53 yrs.
Referred by : Dr. Abc Xyzbar.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right facial palsy.
H/O left facial palsy from which patient recovered in 1 day.

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 in the pons, to the left of the midline. This lesion is iso to hypointense to the normal white matter on the T1 Weighted images and represents an ischemic lesion, most likely recent, in the given clinical setting.

The basilar artery shows an intraluminal signal instead of the normal flow void signal (on spin-echo images) suggesting a slow flow/thrombus within the vessel.

Lacunar infarcts are noted in bilateral thalami.

Ill-defined, hyperintense areas on the T2 Weighted images in the periventricular white matter bilaterally and in the corona radiata and centrum semiovale bilaterally most likely represent ischemic changes.

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


INTRACRANIAL MRA :

The intracranial segments of the vertebral arteries and basilar artery are not visualized. Faint visualization of the posterior cerebral arteries is noted.

Concentric narrowing of the cavernous segment of the internal carotid arteries, bilaterally is noted. Slight narrowing of the distal segment of the right middle cerebral artery is noted.

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

NECK MRA :

There is flattening of the common carotid bulb, bilaterally. The common carotid arteries and their bifurcations are otherwise unremarkable. The visualized vertebral arteries in the neck show normal flow signal characteristics.

IMPRESSION :

1. Altered signal in the pons, to the left of the midline represents an ischemic lesion, most likely recent, in the given clinical setting.

2. Lacunar infarcts in bilateral thalami.

3. Altered signal in the periventricular white matter bilaterally and in the corona radiata and centrum semiovale represent ischemic changes.
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4. Non-visualization of the intracranial segments of the vertebral arteries and basilar artery with intraluminal signal in the basilar artery on the spin-echo sequences may suggest a thrombus in the basilar artery.

5. Concentric narrowing of the cavernous segment of the internal carotid arteries, bilaterally, slight narrowing of the distal segment of the right middle cerebral artery and flattening of the carotid bulbs may be due to atherosclerotic changes.


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