Name of the Patient : Abc Xyz N. Plmn / M / 70 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O paresthesias in BUE and BLE with giddiness and gait imbalance.
H/O left hemiplegia in January 0000.
Now C/O blurred vision since 1 month.
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
5 mm thick FLAIR and Fast Scan (T2 *) coronal images.
5 mm T1 Weighted sagittal images.
There is a well-defined lesion within the right thalamus extending into the right subthalamus and the upper midbrain. This lesion is seen to have a isointense centre with a hypointense periphery on the T1 Weighted images. The periphery is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images with the centre turning hypointense.
Subtle hypointense areas are noted on the proton, T2 Weighted and FLAIR images within the pons anteriorly and are slightly iso to hypointense to white matter on the T1 Weighted images and
are probably ischemic in etiology.
Hyperintense areas are seen on the FLAIR images in the right posterior parieto-occipital region which may represent areas of gliosis.
Lacunar infarcts (isointense to CSF on all the pulse sequences) are seen in the genu of the corpus callosum and internal capsule on the right side.
Paramagnetic substance deposition/calcification is seen in the globus pallidus on the left side.
There is mild fullness of both the lateral, third and the fourth ventricles with mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally.
The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
Incidental note is made of inflammatory changes in the mastoid air cells on the right side.
The MRI features are suggestive of :
1. Altered signal within the right thalamus extending into the right subthalamus and the upper midbrain most probably represent infarcts with paramagnetic substance deposition.
2. Altered signal within the pons anteriorly is probably ischemic in etiology.
3. Areas of gliosis in the right posterior parieto-occipital region.
4. Lacunar infarct in the genu of the corpus callosum and internal capsule on the right side.