Clinical question: Evaluate for ischemia and etiology of seizures, possible epidermoid cyst in right anterior temporal lobe? Signs and symptoms: Left MCA syndrome status post TPA and seizure. Nonenhanced brain MRI:Examination is severely degraded due to extensive motion artifact in particular on axial T2-weighted series.No acute intracranial findings and negative diffusion weighted series.Within limitation of exam compromised secondary to motion artifact there is no evidence of an epidermoid cyst on this study. Examination demonstrates numerous scattered foci of FLAIR and T2 hyperintensity throughout bilateral hemispheric white matter concerning for chronic small vessel ischemic strokes. Similar findings are also present to a lesser degree in bilateral basal ganglia (R>L). There are no detectable similar signal changes in the thalami or the pons. Tiny foci of T2 hyperintensity in the inferior left cerebellum could represent a chronic cerebellar infarct. There is no detectable cortical signal abnormality and the cortical sulci remain within normal. Ventricular system are within normal size for patient's age and with maintained midline.
1.Suboptimal exam due to extensive motion artifact.2.No acute intracranial process and no evidence of an epidermoid cyst as is questioned clinically.3.Findings of chronic small vessel ischemic stroke as detailed above.