Symptomatic contents partial seizures. History of intraventricular hemorrhage. Evaluate for focal, structural abnormality. EEG from Jan 2011 was abnormal; focal slowing over the left parietal region. There are also sharp waves in this left parietal region but no seizures. Areas of susceptibility effect are present at midline, partly in the third ventricle and partly along the medial aspect of the left thalamus, which also shows volume loss. Additional punctate foci of susceptibility effect are present in the occipital horn of the right lateral ventricle and in the trigone of the left lateral ventricle. These are related to previous intraventricular hemorrhage. There is no acute intracranial hemorrhage or acute infarct. There is no mass-effect or midline shift. The biparietal periventricular white-matter is mildly decreased in volume and of slightly increased T2 signal, which reaches to the lateral ventricular surface. These findings are unchanged since the prior examination and most probably reflect prior ischemic injury. The left thalamus is small in size as described above. Otherwise, there is no definite sign of malformation of cortical development. However, the left hippocampus shows asymmetric volume loss and increased T2 signal affecting its head, body and tail, consistent with mesial temporal sclerosis. Volume loss is also noted in the left fornix.Slight asymmetry in the size of the lateral ventricles is unchanged, right being slightly larger than the left. Major intracranial vascular flow voids are preserved. The orbits are unremarkable. There is trace mucosal thickening in the paranasal sinuses which is nonspecific. The mastoid air cells and the middle ear cavities are clear. There is no destructive skull lesion or gross scalp abnormality.
1.Unchanged mild biparietal white-matter volume loss and increased T2 signal, probably reflective of prior ischemic injury. 2.No definite sign of malformation of cortical development. However, the left hippocampus shows asymmetric volume loss and increased T2 signal, consistent with mesial temporal sclerosis. There is associated volume loss of the left fornix.3.Hemosiderin staining in the lateral ventricles and in the third ventricle/left thalamus reflecting prior intraventricular hemorrhage.