sb/hs/rg.
Name of the Patient : Abc XyzBhlmn / M / 85 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O weakness of the RUE, speech disturbances and drowsiness.
Known hypertensive/diabetic.
EXAMINATION :
The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick T1 Weighted sagittal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
OBSERVATION :
There is an ill-defined hyperintense signal on the T2 Weighted images in the left lentiform nucleus extending into the left corona radiata and which most likely represents a recent ischemic lesion.
Lacunar infarcts (iso to hyperintense to CSF) are noted in the right corona radiata, genu of the right internal capsule, in the left lentiform nucleus and in the left external capsular region.
There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the pons, periventricular white matter, in the right frontal region and in the subcortical white matter in the fronto-parietal regions bilaterally, which most likely represent ischemic changes.
There is mild fullness of both the lateral and third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures.
There is no obvious evidence of haemorrhage on this study.
INTRACRANIAL MRA :
There is concentric narrowing of the cavernous and supraclinoid segment of the left internal carotid artery and the supraclinoid segment of the right internal carotid artery. Irregularity and attenuated flow signal is noted in the Sylvian branches of the left middle cerebral artery. Irregularity of the posterior cerebral arteries is also noted with slight narrowing of the terminal basilar artery.
The A1 segment of the left anterior cerebral artery is hypoplastic.
The petrous and cavernous segments of the right internal carotid artery shows normal signal and calibre. The visualized right anterior cerebral, right middle cerebral and vertebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
The left common carotid bifurcation is slightly more proximal as compared to the right.
The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.
IMPRESSION :
1. Altered signal in the left lentiform nucleus extending into the left corona radiata is most likely a recent ischemic lesion.
2. Lacunar infarcts in the right corona radiata, genu of the right internal capsule, in the left lentiform nucleus and in the left external capsular region.
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3. Altered signal in the pons, periventricular white matter, in the right frontal region and in the subcortical white matter in the fronto-parietal regions bilaterally, most likely represents ischemic changes.
4. Mild age related cerebral and cerebellar atrophy.
5. Concentric narrowing of the cavernous and supraclinoid segment of the left internal carotid artery and the supraclinoid segment of the right internal carotid artery with irregularity and attenuated flow signal is noted in the Sylvian branches of the left middle cerebral artery and posterior cerebral arteries may be due to atherosclerotic changes.
6. Narrowing of the tip of the basilar artery may be due to atherosclerotic changes.
As compared to the previous MRI dated 00.00.0000 (Scan No.00004), the ischemic lesion in the left lentiform nucleus extending into the left corona radiata is a new lesion.