 ORBITS: There is mild right sided proptosis. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is abnormal T2 hyperintensity involving the medial and lateral left temporal cortex and to a much more subtle extent the subcortical white matter when windowed narrowly. There may be mild gyral thickening. There is also less prominent minimal T2 hyperintensity questionably involving the left paramedian frontal cortex. There is no abnormal intracranial enhancement.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The cerebellar tonsils lie 5 mm below the foramen magnum but maintain a rounded configuration. There is mild asymmetry of the skull with the sella slightly deviated to the right and a slightly small right hemi-cranium. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.
1.Signal abnormality involving the left frontal and more prominently the left temporal cortex as well as more subtly the left temporal subcortical white matter. The appearance is non-specific but differential diagnosis includes encephalitis, infectious or paraneoplastic in etiology, with neoplasm felt to be less likely. 2.Mild right proptosis that may be secondary to mild skull asymmetry. 3.Minimally low lying cerebellar tonsils. This finding was called by Dr. Michael Rozenfeld to Dr. Hassan Shah on 1/20/2015 at 12:50 PM.