Unspecified convulsions [R56.9], Reason for Study: ^Reason: evaluate for secondary cause of seizure History: seizure with loss of consciousness. There are increased FLAIR/T2 signal intensity lesions with various degree enhancement especially involving gray matter and sulci. The lesions are located at the left frontal lobe superior frontal gyrus and anterior aspect of the left precentral gyrus as well as superior frontal sulcus (series 301, image 27, 28). And at the right temporal lobe, in particular, lateral aspect of the right fusiform gyrus and mesial aspect of the inferior temporal gyrus as well as within the right occipitotemporal sulcus (series 801, image 14 to 21). Especially the lesion located at the right occipito-temporal sulcus shows curvilinear susceptibility artifacts on gradient echo images and focal high signal intensity on T1 images thus could indicate subarachnoid space blood products.In summary, these lesions are mainly involving sulci and adjacent cortical gray matter without definitive mass formation, no diffusion restriction is shown and with mainly sulcal enhancement. These findings are non-specific and diagnostic possibilities include multifocal cortical vein thrombosis, vasculitis, Reversible cerebral vasoconstriction syndrome (RCVS) or inflammatory lesions related to seizure and alcohol consumption such as subacute encephalopathy and seizures in alcoholics (SESA). The possibility of tumourous condition would be slim. There is no evidence of acute ischemic lesion on this scan. The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Enhancing lesions mainly involving sulci and adjacent cortical gray matter at the left frontal lobe and right temporal lobe as described above. Diagnostic possibilities are broad and include cortical thrombosis, vasculitis, RCVS and SESA. Tumorous conditions are unlikely.2. No evidence of acute ischemic lesion.