Name of the Patient : Abc Xyzam Wadlmn / M / 58 yrs.
Referred by : Dr. Abc Xyzatil.
Examination : Intracranial and Neck M.R.A.
CLINICAL PROFILE :
C/O paresthesias in LUE.
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 thickening of the gyri and a hyperintense signal on the FLAIR images in the right posterior temporo-parietal lobes. This appears hypointense to normal white matter on the T1 Weighted images and turns intensely hyperintense on the diffusion Weighted images and would most likely represent a recent area of ischemia/infarction.
Small hyperintense areas on the FLAIR images in the fronto-parietal and periventricular white matter bilaterally turning hypointense to normal white matter on the T1 Weighted images are probably ischemic in etiology.
There is mild dilatation of both the lateral ventricles. The third and fourth ventricles are normal. There is prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally.
There is no shift of the midline structures.
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INTRACRANIAL MRA :
There is mild vessel wall irregularity of the left middle cerebral artery, the petrous segment of the left internal carotid artery and the cavernous segment of the right internal carotid artery.
There is slight attenuation of the Sylvian branches of the left middle cerebral artery.
The right posterior cerebral artery appears to be a continuation of the right posterior communicating artery. There is slight narrowing and irregularity of the right posterior cerebral artery.
The visualized anterior cerebral, basilar, vertebral and left posterior cerebral arteries show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
NECK MRA :
There is slight flattening of the carotid bulb on the right side.
Intraluminal plaque with significant irregularity and stenosis of proximal 2.6 cms of right internal carotid artery and terminal right common carotid artery at the bifurcation is noted.
The left common carotid artery and its extracranial branches appear normal.
IMPRESSION :
1. Altered signal in the right temporo-parietal lobes most likely represent a recent area of ischemia/infarction.
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2. Altered signal in the fronto-parietal and periventricular white matter bilaterally are probably ischemic in etiology.
3. Mild cerebral and cerebellar atrophy.
4. Mild vessel wall irregularity of the left middle cerebral artery with slight attenuation of the Sylvian branches of the left middle cerebral artery.
5. Mild vessel wall irregularity of the petrous segment of the left internal carotid artery and cavernous segment of the right internal carotid artery.
6. Slight narrowing and irregularity of the right posterior cerebral artery.
7. Slight flattening of the carotid bulb on the right side.
8. Intraluminal plaque with significant irregularity and stenosis of proximal 2.6 cms of right internal carotid artery and terminal right common carotid artery at its bifurcation.
Dr. Abc Xyzajan, M.D.
Clinical Assistant