Sudden onset seizures. There is a non-enhancing focus of susceptibility effect in the left anterior frontal lobe, within the deep white matter of the superior frontal gyrus, that measures up to 7 mm. There is no appreciable associated vasogenic edema. There is also an enhancing lesion with serpiginous susceptibility effect involving the lingual sulcus centered the anteromedial left occipital lobe that measures up to 20 mm. In addition, there is a focus of brush-like enhancement and susceptibility effect in the right pons that measures up to 3 mm. There is no evidence of acute intracranial hemorrhage or acute cerebral 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. However, there is a subcentimeter cystic lesion along the lateral aspect of the left temporomandibular joint, which likely represents a synovial cyst.
1. Subcentimeter lesion in the left frontal lobe likely represents a cavernous malformation, without evidence of acute hemorrhage.2. An enhancing lesion involving the left lingual sulcus, centered in the anterior occipital lobe, may also represent a type of vascular malformation. A dedicated MRA or CTA may be useful for further evaluation.3. A punctate enhancing lesion in the right pons is compatible with a capillary telangiectasia.4. Outside imaging is not available on the PACS for comparison at this time.