 There is no restricted diffusion to suggest acute infarct. No evidence of intracranial hemorrhage. There is T2/FLAIR hyperintensity involving the left anterior temporal lobe with focal dilatation of the adjacent left anterior temporal horn. There is mild volume loss including the left hippocampus.There are multiple foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No intracranial mass or evidence of mass effect. No abnormal parenchymal or meningeal enhancement. Major flow voids are preserved. Remainder of the brain and extracranial soft tissues are unremarkable. There is mild patchy opacification of the bilateral ethmoid sinuses as well as the left maxillary sinus. Mild mastoid air cell opacification.
1. No evidence of acute infarct. Gliosis involving the left anterior temporal lobe with adjacent dilatation of the left anterior temporal horn which is favored to be on an ex vacuo basis. Left anterior temporal gliosis may be related to remote trauma, infarct, or other injury. There is much less likely possibility of a benign intraventricular cystic lesion such as neuroglial cyst given the adjacent parenchymal FLAIR abnormality and mild volume loss. 2. Chronic small vessel ischemic disease. 