Name of the Patient : Abc Xyzaben Trilmn / F / 50 yrs.
Referred by : Dr. Abc Xyzagwati.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
H/O craniotomy with duroplasty and removal of flap on 00.00.00.
C/O drowsiness.
EXAMINATION :
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, Proton and T2 Weighted axial images.
5 mm thick FLAIR and 7 mm thick Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.
After administration of contrast the following parameters were used :
5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.
OBSERVATION :
There is evidence of a right sided temporo-parietal craniectomy defect, with mild herniation of the brain parenchyma through the craniectomy defect. A well marginated hyperintense focus on the T1 Weighted images is noted in the cortex/subcortical white matter in the right posterior temporal region, which appears hypointense on the proton and T2 Weighted images and represents an early subacute haemorrhagic focus, most likely the sequelae of previous surgery.
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There is still seen an approximately 2.8 cms diameter sized rim enhancing lesion in the right parieto-occipital parafalcine region. A smaller lesion is noted along the medial margin of the previously described lesion. These lesions appear hypointense on the T1 Weighted images and heterogeneously hyperintense on the T2 Weighted and FLAIR images. There is perilesional white matter edema with effacement of the sulcal spaces, anterior displacement of the atrium, occipital horn and the posterior body of the right lateral ventricle, uncal herniation to the left, effacement of the perimesencephalic and peripontine cisterns, distortion of the upper brainstem axis and subfalcine herniation of the ventricles to the left.
There is mild dilatation of the left lateral ventricle and the frontal horn of the right lateral ventricle. The third ventricle is compressed. The fourth ventricle appears normal.
No obvious vascular anomaly is identified on this study.
After administration of contrast, dural enhancement is noted at the craniectomy site. Patchy enhancement is also noted at the site of the haemorrhagic focus in the right posterior temporal region which may be the sequelae of previous surgery.
Gyral enhancement is noted along the left occipital cortex, medially.
Probable enhancement is seen along the posterior falx, in close relation to the smaller rim enhancing lesion in the right parieto-occipital region.
IMPRESSION :
1. Post-operative status.
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2. Rim enhancing lesions in the right parieto-occipital, parafalcine region as described is not specific for a single etiology. The differential diagnosis would include :
a. Tuberculoma.
b. Metastatic lesions.
c. Primary intracranial neoplasm.
There is resultant significant mass effect as described.
3. Gyral enhancement along the occipital cortex, medially may represent a subacute, enhancing infarct.
As compared to the previous MRI (study no : 00009 dated : 00.00.0000) the patient is now status post-operative. There is slight decrease in the size of the left lateral ventricle. No significant change is noted in the degree of the midline shift on the present study, though the perimesencephalic cisterns and fourth ventricle are better identified on the present study.