Evaluate for occipital seizure focus. There is a punctate focus of diffusion hyperintensity in the left middle frontal gyrus with corresponding T2/FLAIR hyperintensity suspected to represent a tiny subacute infarct.Again seen are postoperative changes of left-sided craniotomy for resection of cavernous reformation at the left temporal-occipital junction. There has been evolution of the previously seen postsurgical changes with decrease in vasogenic edema with minimal FLAIR hyperintensity surrounding the resection cavity compatible with gliosis. There is also susceptibility in this region compatible with hemosiderin staining. There is also a nonspecific linear T2 hyperintensity involving the more anterior left temporal and parietal subcortical white matter. There is a tiny focus of susceptibility in the left frontal lobe involving the left anterior aspect of the cingulate gyrus compatible with chronic microhemorrhage and unchanged since 11/11/2015.Remainder of the brain parenchyma appears within normal limits. Bilateral hippocampi are symmetric and without evidence of mesial temporal sclerosis. No other lesions to suggest seizure focus are appreciated. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal scattered paranasal sinus mucosal thickening and small right maxillary sinus mucus retention cyst.
1. Interval evolution of postsurgical changes related to resection of prior cavernous malformation at the left posterior temporal/occipital lobe junction. There is hemosiderin staining and mild gliosis in this region. 2. Punctate focus of diffusion hyperintensity in the left middle frontal gyrus with associated FLAIR hyperintensity is suspected to represent a focus of subacute ischemia.3. Punctate focus of susceptibility effect in the left frontal lobe involving the left anterior cingulate gyrus is nonspecific, but compatible with chronic microhemorrhage and unchanged.