Seizures despite medications. No seizures or epileptiform activity were captured on EEG during this admission. History is suggestive of localization-related epilepsy (complex and simple partial with possibly right temporal lobe onset) that is intractable, without status epilepticus. There is apparent asymmetry of the hippocampi, right smaller than left. The brain parenchyma and otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Apparent asymmetry of the hippocampi, right smaller than left, without evidence of tumors. This is nonspecific and follow up via a brain MRI with contrast may be useful. 