Medically intractable epilepsy and headaches, presurgical evaluation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is asymmetric T2 hyperintensity involving the right hippocampus with blurring of the internal architecture, but no appreciable swelling or volume loss. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions within the left petrous apex. There are bilateral maxillary sinus retention cysts, left larger than right.
Right hippocampal abnormality likely represents early medial temporal sclerosis.