Diagnosis: Tuberous sclerosis. Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus Benign neoplasm of brain, unspecifiedClinical question: Evaluate SEGA and cortical tubers for change, compare with previous, pt on Afinitor therapySigns and Symptoms: Tuberous sclerosis, seizure The patient is status post right frontal craniotomy.There is redemonstration of a focus of encephalomalacia in the right middle frontal gyrus and right orbital gyrus with some involvement of the pars orbitalis of the right inferior frontal gyrus. There are some contrast enhancement present along the posterior aspect of this signal abnormality which is stable compared to the prior exam.There is redemonstration of multiple cortical tubers scattered in both hemispheres of the brain. One of these in the right temporal lobe displays a small amount of contrast enhancement which is stable compared to prior exam.There is redemonstration of multiple subependymal nodules best seen on susceptibility imaging. There is a focus of hypointensity on susceptibility weighted imaging in the right temporal lobe subcortical white matter associated with a cortical tuber which on FLAIR MRI measures approximately 6 mm. It was also present on the prior exam from 2013 and is unchanged.A T1 hyperintense lesion is present in the left caudate nucleus which was also present on the previous exam and has not changed. It measures 7 mm in sizeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the paranasal sinuses diffusely. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Patient has multiple stigmata of tuberous sclerosis which include multiple subependymoma nodules as well as multiple cortical tubers. These are are stable since the prior exam from 2013.2.There is no evidence for subependymal giant cell astrocytoma appreciated.3.Status post right frontal lobe surgery with associated postoperative change.