Clinical question: Follow-up MRI guided laser ablation for intractable epilepsy. Signs and symptoms: Left temporal epilepsy. Nonenhanced brain MRI:Negative diffusion weighted images.Small well-demarcated focus of minimally hemorrhagic encephalomalacia in the left hippocampal head is detected and representing site of prior laser ablation. The finding measures approximately 20 x 7.7 mm in transaxial dimensions on sagittal T2-weighted series and 9 x 8 mm on coronal T2-weighted series 5 image 16.A thin hemosiderin laden linear signal abnormality extends from the site of laser ablation posteriorly to the left posterior temporal burr hole consistent with track of laser ablation device.Tiny focus of gliosis at the site of the left posterior temporal burr hole and left paramedian frontal burr hole is noted. There is prominence of cerebral cortical sulci and of cerebellar-vermian folia for patient's stated age of 42 consistent with parenchymal volume loss and do not significant change since prior studies.Ventricular system remain within normal size and maintained midline.
1.Focus of minimally hemorrhagic encephalomalacia in the left hippocampal head measuring at 20 x 7.7 mm on axial T2 and 9 x 8 mm on coronal T2-weighted images representing sites of prior laser ablation.2.Prominence of cortical sulci, cerebellar and vermian folia for stated age of 42 without change since multiple prior exams.3.Other expected findings of prior electrode placement as well as laser ablation device as detailed.4.No acute intracranial process and unremarkable exam otherwise. Please see above comments.