Female, 91 years old, with left trigeminal neuralgia and left facial asymmetry, lesion noted within the left temporal lobe on prior incomplete study. As on the prior examination, an area of edema is present within the anterior left temporal lobe. There are several small foci of signal loss/susceptibility within the affected parenchyma which are favored to represent hemosiderin deposition though they could also represent foci of mineralization. In addition, hemosiderin staining is demonstrated along the ependyma of the left temporal horn.The left terminal ICA and proximal MCA within the adjacent sylvian fissure are slightly prominent. In addition, there is ill-defined parenchymal enhancement at the far anterior left temporal lobe as well as probable dural enhancement and prominent venous structures along the adjacent left greater sphenoid wing.Elsewhere, no pathologic parenchymal enhancement is detected. A moderate burden of periventricular T2 hyperintense lesions are demonstrated without edema or mass effect. No restricted diffusion is seen. The ventricular system is within normal limits.Small areas of abnormal marrow signal and ill-defined enhancement are seen within the frontal bones, right side more than left. These lesions do not breach the cortex and demonstrate a benign morphology. A small bony spur osteoma is demonstrated along the left scrotum is temporal bone which does impinge slightly on the lateral temporal lobe.
Edema is seen within the left anterior temporal lobe in association with scattered foci of hemosiderin or perhaps mineralization. Hemosiderin staining is noted along the ependyma of the left temporal horn as well. Mild ill-defined enhancement is seen within the far anterior left temporal lobe parenchyma, along with dural enhancement and prominent venous structures along the left greater sphenoid wing.The differential diagnosis for this abnormality remains broad but the constellation of findings is suspicious for a vascular malformation. An inflammatory or infectious process would be less likely but are not excluded. The possibility of tumor/metastatic disease is not excluded, though this would be an unusual presentation, and in the absence of a known primary, the likelihood is low.