Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus Temporal sclerosisClinical question: h/o epilepsy s/p hippocampal laser ablationSigns and Symptoms: surveillance The patient is status post bilateral parietal bone and right temporal bone burr hole placement. There are T2 and FLAIR hyperintense tracts extending from the burr holes into the brain parenchyma.There is redemonstration of an irregularly shaped ring-enhancing lesions located in the right hippocampal head together which is smaller on the current exam compared to the prior exam and associated with enlargement of the temporal horn of the right lateral ventricle.. This was also present on prior exam from 7/17/2015. On FLAIR MRI imaging it is low signal centrally and high signal peripherally. It is smaller on the current exam compared to the prior. On FLAIR imaging axial dimensions are currently 13 x 8 mm and previously were 19 x 14 mm. There is no evidence for diffusion restriction associated with it.Normal 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
There is a ring-enhancing lesion present in the right hippocampus. Since the prior exam it has decreased in dimensions. Most likely this represents posttreatment effect.