Evaluate for structural abnormality. Intractable epilepsy, status post VNS placement and focality on EEG in right occipital area. There is an asymmetrically convoluted gyration pattern in the right medial occipital lobe. There is patchy T2 hyperintensity in the bilateral parietal lobe periventricular white matter regions, suggestive of terminal zones of myelination. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse mild scalloping along the ependymal surface of the caudates bilaterally. Otherwise, there is no evidence of heterotopia and the ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.
1. An asymmetrically convoluted gyration pattern in the right medial occipital lobe may be associated with cortical malformation, which is otherwise beyond the resolution of this exam. 2. Diffuse mild scalloping along the ependymal surface of the caudates bilaterally without evidence of heterotopia is of uncertain significance, perhaps a developmental variant. 3. No evidence of intracranial hemorrhage, mass, or cerebral edema.