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Name of the Patient : Abc Xyzhelmn / M / 72 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right hemiparesis with slurred speech and incontinence of urine and stool.

EXAMINATION :

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.

OBSERVATION :

There is an ill-defined, hyperintense signal on the T2 Weighted images in the left cerebral peduncle and which most likely represents an ischemic lesion.

Lacunar infarcts are noted in the left thalamus and corona radiata bilaterally.

Ill-defined, hyperintense areas on the T2 Weighted images are noted in the periventricular white matter, corona radiata and centrum semiovale bilaterally and which also represent ischemic changes.

There is moderate dilatation of both the lateral, third and fourth ventricles which is disproportionate to the degree of cerebral cortical and cerebellar atrophy. Prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces is noted bilaterally.

There is no shift of the midline structures.





INTRACRANIAL MRA :

There is slight concentric narrowing and irregularity of the cavernous (superiorly) petrous segments of the right internal carotid artery and of the M1 segment of the right middle cerebral artery.

The right vertebral artery and the A1 segment of the right anterior cerebral artery appears hypoplastic.

The petrous, cavernous and supraclinoid segments of the left internal carotid artery and the supraclinoid segment of the right internal carotid artery show normal signal and calibre. The visualized left anterior cerebral, left middle cerebral, basilar, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The right vertebral artery in the neck appears hypoplastic.

A slight defect is noted at the posterior aspect of the proximal right internal carotid artery just distal to its bifurcation. This may represent an atherosclerotic plaque.

The common carotid arteries and the rest of 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 cerebral peduncle most likely represents an ischemic lesion.
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2. Lacunar infarcts in the left thalamus and corona radiata bilaterally.

3. Altered signal in the periventricular white matter, corona radiata and centrum semiovale bilaterally also represent ischemic changes.

4. Moderate dilatation of both the lateral, third and fourth ventricles is disproportionate to the degree of cerebral cortical and cerebellar atrophy. Normal pressure hydrocephalus should be ruled out.

5. Slight concentric narrowing and irregularity of the petrous and cavernous (superiorly) segments of the right internal carotid artery and of the M1 segment of the right middle cerebral artery may be due to atherosclerotic changes.

6. Hypoplastic right vertebral artery and the A1 segment of the right anterior cerebral artery.

7. A small plaque at the posterior aspect of the proximal right internal carotid artery just distal to its bifurcation.

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