Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: hx of brain mets , ams , seizures History: ams There is redemonstration of left frontal craniotomy changes related to resection of left frontal lobe metastatic lesion with resultant ex vacuo dilatation of the anterior horn of the left lateral ventricle. Scattered areas of enhancement surrounding the surgical bed appears similar to prior examination. There is confluent T2/FLAIR signal surrounding the surgical cavity also similar to prior examination. A dominant enhancing lesion in the left cerebellum appears unchanged from prior examination. A low T1/T2 focus adjacent to the temporal horn of the right lateral ventricle (series 1103, image 85) also appears grossly unchanged without surrounding edema. There is subtle increased T2/FLAIR signal and enhancement which likely represents vascularity involving the left parietal, occipital, and posterior temporal lobes with additional area of increased T2 signal involving the left hippocampus, findings which may be postictal. There is mild fullness of the left parietal lobe gyri. Small foci of diffusion restriction involving the left occipital lobe may be artifactual or also related to postictal state.Several scattered foci of susceptibility likely relating to hemosiderin deposition appear unchanged from prior examination. No midline shift or mass effect is appreciated. There is diffuse mucosal thickening of the left maxillary sinus and mild mucosal thickening of the ethmoid air cells.
1. Redemonstrated postsurgical changes related to resection of left frontal lobe lesion with dominant enhancing lesion in the left cerebellum, similar to prior examination. No new or enlarging lesions to suggest progression of metastatic disease.2. There is subtle increased T2/FLAIR signal and increased vascularity involving the left parietal, occipital, and posterior temporal lobes with additional area of increased T2 signal involving the left hippocampus. These findings are suspected to be postictal in etiology.3. Small apparent foci of diffusion hyperintensity in the left occipital lobe may be artifactual or also related to postictal state.4. There is diffuse mucosal thickening of the left maxillary sinus and mild mucosal thickening of the ethmoid air cells.