Name of the Patient : Abc Xyzh Dhlmn / M / 55 yrs.
Referred by : Dr. Abc Xyzmpat / Dr. Abc Xyzampat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O giddiness.
C/O neckpain with pain radiating to the RUE.

EXAMINATION :

The brain was screened with 5 mm thick FLAIR axial and T1 Weighted sagittal images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There is an ill-defined, hyperintense signal on the FLAIR images in the right inferior frontal cortex/subcortical white matter (se/im:102/8) (along the anterior commisure). This lesion appears iso to hypointense to normal white matter on the T1 Weighted images.

There are small bright foci on the FLAIR images in the frontal deep white matter bilaterally, which are iso to hypointense to normal white matter on the T1 Weighted images.

Both the lateral, third and fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is slight prominence of the cerebellar folia bilaterally.

There is no shift of the midline structures.






Inflammatory changes are noted in the right maxillary sinus.

Note is made of an empty sella.

INTRACRANIAL MRA :

The right posterior cerebral artery appears as a continuation of a right posterior communicating artery.

There is mild concentric narrowing of the mid cavernous segment of the right internal carotid artery, the mid segment of the right posterior cerebral artery and the terminal left vertebral artery.

The petrous, cavernous and supraclinoid segments of the left internal carotid artery and the petrous and supraclinoid segments of the right internal carotid artery show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, right vertebral and left posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The left vertebral artery is slightly hypoplastic as compared to the right.

The common carotid arteries and their extracranial branches appear normal bilaterally.
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IMPRESSION :

1. Altered signal in the right inferior frontal cortex/subcortical white matter is not specific for a single etiology. The differential diagnosis may include,

a. Gliotic changes due to previous contusion.

b. Less likely to represent focal encephalitis/ischemia.

2. Altered signal in the frontal deep white matter bilaterally most likely represent ischemic lesions.

3. Mild concentric narrowing of the mid cavernous segment of the right internal carotid artery, the mid segment of the right posterior cerebral artery and the terminal left vertebral artery.