Name of the Patient : Abc Xyzr Blmn / M / 65 yrs.
Referred by : Dr. Abc Xyzvale.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O right hemiparesis since 2 days with slurred speech.
Also C/O decreased hearing since 20 years.
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.
Lacunar infarcts (iso to hyperintense to CSF) are noted in the left cerebellar hemisphere, pons, lentiform nuclei bilaterally, corona radiata and centrum semiovale bilaterally, left anterior capsular region and in the genu of the corpus callosum on the right.
There are ill-defined, areas which are near isointense to CSF in the left cerebellar hemisphere inferiorly. These areas represent an old infarcts. Hyperintense areas on the T2 Weighted images are noted in the periventricular white matter bilaterally, which may represent ischemic changes.
There is mild fullness of both the lateral, third and the fourth ventricles. 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 irregularity and narrowing of the posterior cerebral arteries bilaterally.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized 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 :
The left vertebral artery appears slight hypoplastic as compared to the right.
The common carotid arteries and their bifurcations appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
1. Lacunar infarcts in the left cerebellar hemisphere, pons, lentiform nuclei bilaterally, corona radiata and centrum semiovale bilaterally, left anterior capsular region and in the genu of the corpus callosum on the right.
2. Altered signal in the left cerebellar hemisphere inferiorly would represent an old infarcts.
3. Altered signal in the periventricular white matter bilaterally may represent ischemic lesions.
4. Slight irregularity and narrowing of the posterior cerebral arteries bilaterally may be due to atherosclerosis.