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ke/sb/nl/rg.

Name of the Patient : Abc XyzBelmn / M / 90 yrs.
Referred by : Dr. Abc Xyzraf.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O left sided hemiparesis with thalamic bleed in October 0000.
C/O giddiness since then.
Known hypertensive.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick Fast Scan (T2 *) coronal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There is a linear hyperintense area with hypointense signal on the T2 Weighted and Fast Scan (T2 *) images in the right thalamus, which represents residual hemosiderin, the result of previous hematoma.

There are hyperintense areas on the T2 Weighted images in the pons, left thalamus and periatrial deep white matter. These are isointense to the white matter on the T1 Weighted images and are probably ischemic in etiology.

Lacunar infarcts are noted within the splenium of the corpus callosum on the right side (scan 102/11) and left corona radiata anteriorly.

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


INTRACRANIAL MRA :

There is irregularity of the left posterior cerebral artery distal to the P2 segment. Slight narrowing is also noted in the distal portion of the P2 segment of the right posterior cerebral artery and the distal cavernous and supraclinoid segments of the right internal carotid artery.

The A1 segment of the left anterior cerebral artery is hypoplastic.

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

NECK MRA :

There is slight narrowing of the internal carotid artery on the left side at the level of its bifurcation with small filling defect posteriorly which may be an atherosclerotic Plaque. A probable plaque/wall calcification is noted along the postero-medial wall of the proximal right internal carotid artery.

The common carotid arteries and their extracranial branches appear normal bilaterally.

IMPRESSION :

1. Altered signal in the right thalamus represents residual
hemosiderin, the result of previous hematoma.

2. Altered signal in the pons, left thalamus and periatrial deep white matter are probably ischemic in etiology.
..3/.







- 3 - Scan-00005


3. Lacunar infarcts in the splenium of the corpus callosum on the right and in the left corona radiata, anteriorly.

4. Irregularity of the left posterior cerebral artery distal to its P2 segment and slight narrowing of the distal portion of the P2 segment of the right posterior cerebral artery.

5. Narrowing of the distal cavernous and supraclinoid segment of the right internal carotid artery.

6. Slight narrowing of the internal carotid artery on the left side at the level of its bifurcation with small filling defect posteriorly which may be an atherosclerotic plaque. Probable plaque/wall thickening along the postero-medial wall of the proximal right internal carotid artery.

As compared to the previous CT Scan dated 00.00.00, there is significant reduction in the size of the hematoma





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