Röntgendiagnostik, Nuklearmedizin, Computertomographie, Sonographie, DSA (Angiographie), Kernspintomographie

Speersort 8, D - 20095 Hamburg, Tel.: +49 40 - 33 09 15, +49 40 - 325 5520, Fax: +49 40 - 32 49 50

Dr. E.-U. Bieler, Radiologie und Nuklearmedizin

Dr. Rene Rückner, Radiologie

Dr. Rudolf Rieser, Radiologie

Dr. Andreas Keulers, Radiologie

Dr. Joachim Schubert, Diagnostische Radiologie


Datum: 9.9.97 / KEU*sch
 

Klinik/Fragestellung

Opticusneuritis
 

Kernspintomographie (MRT) des Neurocraniums vom 9.9.97

Sequenzen:

Axial, TSE-intermediär - /T2
Coronal, TIR - T2
Sagittal, dark fluid T2
Axial, TSE - T1 nach Gadolinium i.v. (magnetic transfer)

Zum Vergleich liegen Vorbilder vom 26.8.97 vor.
Ein Herd hochfrontal rindennah im Marklager rechts hat eindeutig an Größe zugenommen und mißt heute etwa 1.8 cm und zeigt nach Gadolinium i.v. ein kräftiges ringförmiges Enhancement. Auch weitere Herde, teils periventrikulär, teils rindennah, sind Kontrastmittlel-aufnehmend abgebildet. Der Hirnstamm selber unauffällig. Die sagittale Dark-fluid-T2-Sequenz zeigt einen unauffälligen Balken, die Balkenstrahlung allerdings mit oben erwähnten signalreichen Herden und den übrigen teils rindennah gelegenen Signalerhöhungen. Auch im Kleinhirn sind punktförmige Signalerhöhungen im Mark sichtbar. Des weiteren der N. opticus links in der TIR-T2-Sequenz signalangehoben. Rechts dagegen signalarm.
 

Beurteilung:


The Presbyterian Hospital

in the City of New York
at

Columbia Presbyterian Medical Center

Department of Radiology

Images reviewed, report edited and signed by
A. John Silver, MD.
January 22, 1998, 10:34
Date: January 20, 1998
Location: Milstein Hospital
Ord. Dr.: Liegner, Kenneth, 8 Barnard Road, Armonk, N.Y. 10504

Exam: MBMR Brain with and without Contrast
Clinical Information: Lyme Disease
 

Description:

Multiple T1 sagittal and axial pre and post contrast, proton density and T2 weighted axial, proton density and T2 weighted coronal and post-contrast T1 coronal images of the brain were obtained.
 

Findings:

Comparison with a previous outside study dated September 9, 1997: Again noted are multiple periventricular white matter and inferior margianl corpus callosal lesions that show increased signal on T2-weighted images. Post contrast, many of theses lesions are seen to enhance, the largest of which is in the right frontal subcortical white matter which is ring enhancing. The present study shows marked improvement of the enhancement pattern with only slight focal enhancement in a single lesion in the right parietal lobe.

There are multiple rounded foci of increased T2 signal in the bilateral frontoparietal white matter as well as the periventricular white matter in the right temporal region. One of these foci in the right parietal lobe demonstrates possible slight focal enhancement. No significant mass effect is noted.

There is no evidence of cortical infarction, intracranial hemorrhage. No obstructive hydrocephalus or midline shift or herniation is noted.

Mucosal thickening is noted within the bilateral maxillary sinuses and sphenoid sinuses consistent with sinusitis.
 

Impression:

  1. Multiple bilateral frontoparietal and right temporal white matter foci of abnormal signal with questionable enhancement in the right parietal region. These lesions are of uncertain etiology and may represent possible granulomatous disease including Lyme Disease. Multiple infarcts secondary to etiology like vasculitis are less likely. However, since several of these lesions are possibly corpus callosal lesions, multiple sclerosis demyelinating plaques cannot be ruled out.
  2. Maxillary and shenoid sinusitis.



The Presbyterian Hospital

in the City of New York
at

Columbia Presbyterian Medical Center

Department of Radiology

Images reviewed, report edited and signed by
A. John Silver, MD.
September 28, 1998, 9:13

Date: September 28, 1998
Location: Milstein Hospital
Ord. Dr.: Liegner, Kenneth, 8 Barnard Road, Armonk, N.Y. 10504

Exam: MBMR Brain with and without Contrast
Clinical Information: Lyme Disease

Description:

MRI of the brain was performed utilizing sagittal T1, axial T1, prton density, T2 and post gadolinium, axial, coronal, and sagital T1-weighted sequences.

Comparison was made with prior MRI dated January 20, 1998. The previously noted frontal perietal white matter lesions appear unchanged as compared to the prior study dated Jan. 20, 1998. The findings are as in the prior impression.
 

Impression:

No significant change in the frontal parietal white matter lesions as compared to prior study suggests static lesions.



Oral comment given:
 
 
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Home Version: 9. April 2002.