Clinical question: Evaluate for etiology of breakthrough seizures, history of temporal lobe epilepsy. Signs and symptoms: Breakthrough seizures. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.On coronal flair/T2 series examination demonstrate increased signal intensity on the left hippocampus with suggestion of subtle underlying parenchymal volume loss and resultant enlargement of adjacent sulci and the tip of left temporal horn consistent with mesial temporal sclerosis. There are no prior MRI exams for comparison.Examination also demonstrates subtle uniform prominence of cerebral cortical sulci for patient's stated age of 30. The ventricular system are also mildly prominent in particular on the left side for stated age. Extensive signal abnormality in bilateral frontal horns (left greater than right) is consistent with ulceration artifact and not a true pathology.Myelination of the brain remains within normal.Images through posterior fossa are unremarkable.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and mid normal pattern of enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.No acute intracranial process.2.Findings of mesial temporal sclerosis on the left as detailed.3.Mild uniform prominence of cerebral cortical sulci for patient's stated is noted. 4.Unremarkable pre-and post enhanced brain MRI otherwise.