Female, 59 years old, with persistent abnormal smells, unilateral leg weakness, lung transplant patient. Concern for onset of temporal lobe seizures. Assess for structural lesions. Diffusion-weighted images are unremarkable. Numerous scattered foci of T2 hyperintensity are demonstrated within the bilateral cerebral white matter, unchanged from the prior exam. A few areas of cortical signal abnormality are also stable, for example involving the left parietal lobe and high right middle frontal gyrus.As on the prior examination, an oval cystic lesion is seen interposed between the substantia nigra and red nucleus on the right of the midbrain. This lesion follows CSF signal on all sequences and has not changed.There are a few scattered punctate foci of susceptibility in the brain which are of doubtful significance and may simply represent chronic microhemorrhage. No acute intracranial hemorrhage is suspected. Ventricles are stable and normal in size.A partially empty sella is unchanged. The marrow signal characteristics are unremarkable.
1. Sequelae of chronic microvascular and perhaps chronic cortical ischemia. No evidence of acute ischemia or any other acute findings.2. No change in the appearance of the temporal lobes with no specific lesions seen which would account for the patient's symptoms.3. Stable cystic lesion within the right midbrain which may represent a dilated perivascular space.