ke/sb/nl/rg.
Name of the Patient : Abc Xyza Jalgaolmn / F / 52 yrs.
Referred by : Dr. Abc Xyznkhla / Dr. Abc Xyzrani.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O right sided weakness 20 days back from which patient recovered.
C/O left sided weakness 3 days back with slurred speech since 3 days.
Known hypertensive.
EXAMINATION :
The brain was screened with 5 mm thick T2 Weighted axial images and 5 mm thick FLAIR coronal images.
Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.
OBSERVATION :
There is a large area in the left temporal lobe which is predominantly hypointense to white matter on the T1 Weighted images with hyperintense periphery. This is seen to turn hyperintense on the T2 Weighted and FLAIR images and represents a hemorrhagic infarct. There is surrounding edema encroaching into the left external capsule and the posterior limb of the left internal capsule. There is mass effect with effacement of the left Sylvian fissure and the adjacent sulci and mild bulge of the midline structures to the right.
The brainstem is unremarkable.
There is fullness of both the lateral ventricles. The third and fourth ventricles are normal. The basal cisternal spaces are unremarkable.
Incidental note is made of inflammatory changes in the sphenoid sinus on the right.
INTRACRANIAL MRA :
There is paucity of the Sylvian branches of the left middle cerebral artery with medial and superior displacement of the distal portion of the left middle cerebral artery and its Sylvian branches.
The A1 segment of the right anterior cerebral artery is hypoplastic.
Slight irregularity of the cavernous segment of the left internal carotid artery is noted.
The petrous, cavernous and supraclinoid segments right of the internal carotid artery show normal signal and calibre. The visualized left anterior cerebral, right middle cerebral, basilar, vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
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. A haemorrhagic infarct in the left temporal lobe.
2. Paucity of the Sylvian branches of the left middle cerebral artery with medial and superior displacement of the distal portion of the left middle cerebral artery and its Sylvian branches.
3. Hypoplastic of the A1 segment of the right anterior cerebral artery.
4. Slight irregularity of the cavernous segment of the left internal carotid artery.