sb/ke/nl/rg.
Name of the Patient : Abc Xyzr Doodhlmn / M / 48 yrs
Referred by : Dr. Abc Xyzvale.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
H/O fever with chills on 00.00.0000 with discharge from right ear. Diagnosed C/O pyogenic meningitis. On Rx since then.
H/O comatose state since 00.00.0000.
EXAMINATION :
The brain was screened with 5 mm thick T2 Weighted axial images and FLAIR coronal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
OBSERVATION :
There are ill-defined, hyperintense areas on the T2 Weighted and FLAIR images along the cortex and subcortical white matter in the right fronto-temporo-parietal region, left fronto-parietal region and in the lentiform nuclei and corona radiata bilaterally. These lesions appear predominantly hypointense on the T1 Weighted images. Patchy hyperintense signal on all the pulse sequences is also noted within these lesions. There is resultant effacement of the cerebral cortical sulci in these regions.
Mild fullness of both the lateral and third ventricles. The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Inflammatory changes are noted in the middle ear cavities bilaterally and the sphenoid sinus.
Incidentally noted is an empty sella.
INTRACRANIAL MRA :
The left vertebral artery is not visualized. The right vertebral artery continues as the basilar artery and is slightly hypertrophied.
There is slight irregularity and narrowing of the middle cerebral arteries and its Sylvian branches and the distal posterior cerebral arteries bilaterally.
The A1 segment of the left anterior cerebral artery is probably hypoplastic.
The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized right anterior cerebral artery also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The vertebral arteries in the neck are faintly visualized and are probably hypoplastic.
There is overall smaller calibre of the left common carotid artery and the proximal left internal and external carotid arteries in the neck. A plaque is noted along the postero-lateral wall of the proximal left internal carotid artery just distal to the common carotid bifurcation.
The right common carotid artery and its bifurcations are unremarkable (Flow related artifacts are noted at the right common carotid bifurcation).
..3/.
- 3 - Scan-00000
IMPRESSION :
1. Altered signal in the cortex and subcortical white matter in the right fronto-temporo-parietal region, left fronto-parietal region and in the lentiform nuclei and corona radiata bilaterally represent recent haemorrhagic infarcts.
2. Slight irregularity and narrowing of the middle cerebral arteries and its Sylvian branches and the distal posterior cerebral arteries bilaterally, with attenuated flow signal.
3. Overall smaller calibre of the left common carotid artery and the proximal left internal and external carotid arteries in the neck.
4. A plaque along the postero-lateral wall of the proximal left internal carotid artery.