Name of the Patient : Abc Xyz Vallmn / M / 45 yrs.
Referred by : Dr. Abc Xyzankhla.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
Alleged H/O RTA with loss of consciousness since then.
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.
OBSERVATION :
There is seen a subdural hematoma in the right fronto-temporal region with a maximum width of about 1.3 cms. This lesion is isointense to normal grey matter on the T1 Weighted images but appears hyperintense on the T2 Weighted images and blooms, in some places on the Fast Scan (T2 *) images. There is resultant effacement of the sulcal spaces in the right cerebral hemisphere with compression of the right lateral and third ventricles and shift of the midline structures to the left. There is distortion of the upper brainstem axis.
There are ill-defined hyperintense areas on the proton, T2 Weighted and FLAIR images in the right cerebellar hemisphere, inferiorly, midbrain and the pons and in the inferior frontal regions bilaterally. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images. The lesion in the inferior frontal regions and right cerebellar hemisphere represent contusions whereas the brainstem lesions most likely represent shearing injuries.
Layering is noted in the atrium and posterior body of the left lateral ventricle which may suggest intraventricular haemorrhage. Intraventricular haemorrhage is also noted in the fourth ventricle. The cerebellar tonsils appear low-lying.
There is a hyperintense signal on the FLAIR images in the subarachnoid spaces overlying the cerebral hemispheres bilaterally and in the suprasellar cistern and perimesencephalic cisterns. This suggest subarachnoid haemorrhage.
Subgaleal hematomas are noted in the right fronto-temporo-parietal region, left posterior parietal region and in the right periorbital region.
There is mild dilatation of the left lateral ventricle.
Intraluminal signal is noted in the superior sagittal sinus and in the transverse and sigmoid sinuses bilaterally. The petrous and cavernous segments of the internal carotid arteries show attenuated flow signal.
Fracture of the right pareital bone is noted.
IMPRESSION :
1. A subdural hematoma in the right fronto-temporal region with a maximum width of about 1.3 cms, with resultant mass effect as described.
2. Cortical contusions in the inferior frontal regions and right cerebellar hemisphere.
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3. Altered signal in the brainstem most likely represent shearing injuries.
4. Intraventricular haemorrhage in the atrium and posterior body of the left lateral ventricle.
5. Subarachnoid haemorrhage over the cerebral hemispheres bilaterally and in the suprasellar cistern and perimesencephalic cisterns.
6. Subgaleal hematomas in the right fronto-temporo-parietal region, left posterior parietal region and in the right periorbital region.
7. Intraluminal signal in the superior sagittal sinus and in the transverse and sigmoid sinuses bilaterally and attenuated flow void signal in the petrous and cavernous segments of the internal carotid arteries bilaterally may suggest slow flow. Brain death should be ruled out.
8. Fracture of the right parietal bone.