Name of the Patient : Abc Xyzlmn / F / 52 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
H/O right parieto-occipital craniotomy in 0000 for an astrocytoma. Received chemotherapy and radiotherapy.
Now C/O drowsiness 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 coronal images.
After administration of contrast the following parameters were used :
5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.
There is a right parieto-occipital craniotomy.
An ill-defined hypointense area is seen in the right parieto-occipital region on the T1 Weighted images which is seen to follow CSF signal intensity characteristics on all the pulse sequences. Hyperintense areas are seen on the proton, T2 Weighted and FLAIR images and which are hypointense to white matter on the T1 Weighted images adjacent to this lesion and would represent areas of gliosis. These lesions in toto would represent areas of cystic encephalomalacia.
Similar areas are noted in the left periatrial white matter and bilateral corona radiata and centrum semiovale posteriorly. There is resultant dilatation of the atrium and occipital horns of both the lateral ventricles and these areas would most likely
represent gliotic changes (with a few cystic changes).
A lacunar infarct (isointense to CSF on all the pulse sequences) is seen in the left corona radiata and extending into the posterior limb of the left internal capsule.
Small bright foci are noted on the proton, T2 Weighted and FLAIR images in the fronto-parietal deep white matter. These are isointense to white matter on the T1 Weighted images and are probably ischemic in etiology.
On administration of contrast, there is very faint enhancement in the right para-atrial deep white matter and the operative site and is probably due to post-operative chagnes.
There is no other area of abnormal enhancement within the brain parenchyma or along the meninges.
There is dilatation of both the lateral ventricles. There is mild fullness of the third and the fourth ventricles. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
The MRI features are suggestive of :
1. Post-operative status.
2. Areas of encephalomalacia in the right parieto-occipital region, in the left periatrial white matter and bilateral corona radiata and centrum semiovale, posteriorly.
3. A lacunar infarct in the left corona radiata extending into the posterior limb of the left internal capsule.
4. Areas of altered signal in the fronto-parietal deep white matter are probably ischemic in etiology.
As compared to the previous MRI dated 00.00.00, there appears to be slight increase in the dilatation of the atrium of the occipital horns of the lateral ventricles and the enhancement in the frontal region is no longer identified on this study.