Name of the Patient : Abc Xyzilal lmn / M / 62 yrs.
Referred by : Dr. Abc XyzShah.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O hemianopia, slurred speech, gait ataxia and giddiness.
The brain was screened with 5 mm thick T2 Weighted axial images 5 mm thick FLAIR coronal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
There is evidence of an area of hyperintensity on the T2 Weighted and FLAIR images within the pons, at its right lateral aspect and this is most likely ischemic in etiology.
A lacunar infarct (iso to hyperintense to CSF) is noted within the right thalamus.
There is fullness of the third and both the lateral ventricles. Also seen is slight prominence of the cerebral cortical sulci.
The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
INTRACRANIAL MRA :
The right vertebral artery is not well visualized. There is flow signal attenuation within the right posterior cerebral artery and this is slightly narrowed. Slight narrowing of the mid segment of the left posterior cerebral artery is also noted.
There is irregularity and narrowing of the petrous and cavernous segments 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, middle cerebral, basilar, left vertebral and left posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The right vertebral artery is smaller in calibre as compared to the opposite side.
The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
The MRI features are suggestive of :
1. An area of altered signal intensity within the pons, at its right lateral aspect is most likely ischemic in etiology.
2. Non-visualization of the intracranial right vertebral artery and a smaller calibre of the right vertebral artery in the neck.
3. Narrowing of the right posterior cerebral artery with flow attenuation and narrowing of the mid segment of the left posterior cerebral artery.
4. Irregularity and narrowing of the petrous and cavernous segments of the left internal carotid artery.