40 years Female (DOB:1/24/1976)Reason: please evaluate for expansion of diffusion changes in the affected area History: epilepsia partialis continua manifesting as RLE twitching refractory to 6 AEDs, has diffusion restriction in the mesial part of the left precentral regionPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI There is a gyriform T2 and FLAIR hyperintense lesion involving the anterior aspect of the left paracentral lobule which was smaller on the 5/19/2016 exam when it measured 8 x 7 mm axial dimensions. It is hyperintense on diffusion-weighted imaging but does not display diffusion restriction.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.
A left paracentral lobule lesion has enlarged relative to the prior exam from 5/19/16. It does not appear to be related to ischemia but rather may represent an inflammatory lesion and may represent encephalitis given the rapid enlargement. Although neoplasms may have similar appearance one would not expected a neoplasm to enlarge this rapidly. Therefore neoplasm is less likely.