Posterior Circulation Insufficiency (MR).

PROTOCOL:

T1W – Sagittal & axial scans
T2W – Axial & coronal scans
FLAIR – Axial scans 

FINDINGS:

-Revealed:
• Area of encephalomalacia in the medial part of the left cerebellum with 28 x 25 mm diameters and mild peri focal area of gliosis.
• Abnormal heterogeneous faint restricted diffusion in the whole left cerebellum; left middle cerebellar peduncle; pons; cerebellar vermis and the medial portion of the right temporal lobe with no corresponding restriction on ADC maps images.
• Almost non visualization of the left vertebral artery and attenuation of the basilar artery.
• Normal morphology of MR venography.
• After contrast injection; abnormal enhancement of gyriform pattern in the left cerebellum.

-The rest of the brain Parenchyma shows normal grey white matter differentiation and signal intensities.  No focal mass lesion is seen.
-Lateral and third ventricles are normal in size and position. Septum is in midline.  There is no midline shift.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Sella is normal in appearance. 
-Corpus callosum shows normal MR morphology.
-Fourth ventricle is normal in size and is midline in position.


OPINION:

• Left cerebellar area of encephalomalacia with gyriform enhancement around.
• Non visualization of the left vertebral artery and attenuation of the basilar artery.
• Impaired blood supply of left cerebellum; left middle cerebellar peduncle; cerebellar vermis and pons in addition to the right temporal lobe.


Reported By : DR.MOHAMMED MOHYELDIN
 Consultant-Radiologist