ke/sb/rg/nl

Name of the Patient : Abc XyzBhlmn / M / 54 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O right sided hemiparesis with slurred speech 1 year ago. Recovered partially.
C/O giddiness with vomiting (one episode) and weakness in BLE in February 0000 from which patient recovered.
C/O memory impairment.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.
4 mm thick FLAIR coronal images.
5 mm thick Fast Scan (T2 *) coronal images.

OBSERVATION :

There is an ill-defined signal on the proton, T2 Weighted and FLAIR images in the pons slightly more to the right of the midline at the junction of the midbrain and pons anteriorly. This lesion appears hypointense to normal white matter on the T1 Weighted images and most likely represents an ischemic lesion.

Lacunar infarcts are noted in the cerebellar hemispheres bilaterally with the left cerebellar infarct extending upto the superior cerebellum on the left. Lacunar infarcts are also noted in the left parathird ventricular region and in the left anterior capsular region.

There is a linear hyperintense signal on the proton, T2 Weighted and FLAIR images in the right external capsular region extending into the right corona radiata. This lesion appears hypointense on the T1 Weighted images. Resultant mild dilatation of the right lateral ventricle is noted as compared to the left.
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There are ill-defined hyperintense areas on the proton, T2 Weighted and FLAIR images in the periventricular white matter bilaterally and in the subcortical white matter in the frontal and parietal regions bilaterally.

There is mild dilatation of both the lateral and the third ventricles. The fourth ventricle is normal. There is slight prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

1. Altered signal in the pons slightly more to the right of the midline at the junction of the midbrain and pons anteriorly
most likely represents an ischemic lesion.

2. Lacunar infarcts in the cerebellar hemispheres bilaterally (with the left cerebellar infarct extending upto the superior cerebellum on the left) and in the left parathird ventricular region and left anterior capsular region.

3. Altered signal in the right external capsular region extending into the right corona radiata may either be the sequelae of a previous intracerebellar hematoma or may be the sequelae of a previous vascular insult.

4. Ill-defined altered signal in the periventricular white matter bilaterally and in the subcortical white matter in the frontal and parietal regions bilaterally most likely represents ischemic changes.

5. Mild cerebral and cerebellar atrophy.