ke.sb.rg.





Name of the Patient : Abc Xyzanu Clmn / F / 19 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Known C/O TB Meningitis with seizures. On AKT since 5 months.

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 T2 Weighted and FLAIR coronal images.
7 mm thick Fast Scan (T2 *) coronal images.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There are multiple well-defined hypointense lesions on the T1 Weighted images within the right parieto-occipital region. This lesion appears hyperintense (with a peripheral hypointense rim) on the proton and T2 Weighted images. There is perilesional edema with effacement of the sulcal spaces in the right parieto-occipital region with slight inferior and anterior displacement of the atrium of the right lateral ventricle.

Similar altered signal intensity areas are seen in the left occipital region.

Subtle hyperintense areas are noted in the left high frontal parafalcine region, better appreciated on the T2 Weighted and FLAIR images (scans 105.12-13, 106.12-13). These are hypointense to the white matter on the T1 Weighted images. A very small lesion is seen in the left high frontal parafalcine region which measures approximately 0.5 x 1.0 cms and follows CSF signal intensity characteristics on all the pulse sequences and may represent residual lesion/cystic encephalomalacia. A burr hole is noted in that region.
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The left lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Inflammatory changes are noted in the left mastoid air cells and the left maxillary polyp.

IMPRESSION :

In a known C/O TBM, the MRI features are suggestive of :

1. Multiple lesions in the parieto-occipital region on the right side with significant edema and mass effect as described.

2. Altered signal in the left occipital region may represent residual lesion.

3. Altered signal in the left high frontal parafalcine region, may represent residual lesion/cystic encephalomalacia,
the result of previous intervention.

As compared to the previous MRI Scan (Scan 00009) dated 00.00.0000,

a. There is increase in the number of the lesions and edema in the right parieto-occipital region.

b. A few residual lesions in the left occipital region.

c. There is near complete resolution of the abscess in the left high frontal, parafalcine region.

A contrast enhanced scan would be worthwhile.