Seizure/epilepsy. History of left subdural hemorrhage. Susceptibility artifact in the left parietal region slightly limits evaluation of the adjacent parenchyma. There is evidence of encephalomalacia involving the left inferior parietal lobule with evidence of remote left-sided craniotomy. Minimal herniation of brain parenchyma is noted via the craniectomy site. There are additional smaller areas of encephalomalacia involving the left occipital lobe including the lingual gyrus and the left inferior temporal lobe involving primarily the left parahippocampal gyrus. Volume loss involving the left hippocampus is noted. There is FLAIR hyperintensity involving the left hippocampus and to a much greater degree in the left parahippocampal gyrus. Old right temporal burr hole is also noted.Few scattered T2 hyperintense foci in the white matter are nonspecific. No intracranial mass or mass effect. Mild ex vacuo dilatation of left lateral ventricle. No hydrocephalus. No abnormal parenchymal or leptomeningeal contrast enhancement. Major intracranial vessels are patent. The orbits are normal. Mild ethmoid and maxillary mucosal thickening. Mastoid air cells are clear.
1.Multifocal encephalomalacia involving the left parietal, left temporal, and left occipital lobes which may represent sequela of prior trauma.2.Asymmetric volume loss involving the left hippocampus with mild FLAIR hyperintensity, which may be related to direct injury seen more extensively in the adjacent left parahippocampal gyrus versus secondary mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.