Surgical planning: seizure. Per EPIC: brain lesion (unclear pathology), CVA during biopsy in 1990 with residual left sided weakness and seizure disorder. There are postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe. There is a large area of encephalomalacia in the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata with extensive susceptibility effect, Wallerian degeneration in the brainstem, and ex vacuo dilatation of the adjacent ventricles. There is linear high T2 signal in the left brainstem, which may also represent Wallerian degeneration. There is a punctate area of encephalomalacia in the left corona radiata. There are scattered foci of susceptibility effect in the right frontal lobe and overlying extra-axial space, which correspond to dystrophic calcifications demonstrated on CT. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.
1. Postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe, but no definite gross tumor. 2. Chronic hemorrhagic infarction involving the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata.3. Punctate chronic lacunar infarct in the left corona radiata.