Clinical question: Tuberous sclerosis. Now with headaches. Assess for etiology. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates postoperative changes left paramedian posterior parietal craniotomy without change since prior exam. The underlying parenchyma demonstrate no detectable signal abnormality or parenchymal/leptomeningeal enhancement similar to prior study.Few punctate foci of nonspecific FLAIR hyperintensity without detectable enhancement in the subcortical white matter of bilateral cerebral hemispheres in a nearly identical to prior exam from 2012.Unremarkable cerebral cortex and cortical sulci, ventricular system and CSF spaces as well as brain myelination otherwise and without evidence of abnormal enhancement.The signal voids of major intracranial arterial branches are identified. The signal void of intracranial venous sinuses are within normal with normal pattern of enhancement.Calvarium is otherwise unremarkable.Images through the orbits and including axial fat sat post enhanced series are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.Negative diffusion-weighted images.2.Stable chronic postoperative changes of the left posterior parietal paramedian craniotomy.3.Stable few punctate foci of FLAIR hyperintensity in bilateral cerebral hemispheres without enhancement since prior exam.4.Unremarkable intracranial contents otherwise and without evidence of abnormal enhancement.5.Unremarkable calvarium otherwise.6.Well-pneumatized paranasal sinuses and mastoid air cells/middle ear cavities.