Name of the Patient : Abc Xyz Velinlmn / F / 65 yrs.
Referred by : Dr. Abc Xyzvale.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O sudden onset of ptosis of the right eye since 3-4 days.
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
3 mm thick T1 Weighted and STIR coronal images.
5 mm thick T1 Weighted sagittal images.
There is small bright focus on the proton and T2 Weighted images in the subcortical white matter in the right posterior parietal region which most likely represents an ischemic lesion (scans 102.13). Dilated perivascular spaces are seen in the centrum semiovale bilaterally.
There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images at the right orbital apex, extending slightly distally along the roof of the right orbit (scans 106.6-8). This lesion appears slightly hyperintense on the STIR images. A similar, signal intensity lesion is noted along the supero-medial quadrant towards to apex of the left orbit (scans 106.8).
The optic nerves on either side show normal signal intensity. The sella and suprasellar region are unremarkable. The cavernous sinuses are also unremarkable.
There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is slight prominence of the cerebral cortical sulci and cerebellar folia bilaterally.
The basal cisternal spaces are prominent. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
1. Altered signal in the subcortical white matter in the right posterior parietal region most likely represents an ischemic lesion.
2. Soft tissue lesion at the right orbital apex, extending slightly distally along the roof of the right orbit as described most likely represents an inflammatory granuloma, probably an orbital pseudotumor. Suspicious, similar lesion is noted along the supero-medial quadrant along the left orbit apex.
The possibility of these lesions representing a neoplasm
may be considered as differential diagnosis though less likely.
A contrast enhanced scan would be worthwhile.