 A 5 mm focus of T2 hyperintensity with associated mild enhancement and restricted diffusion is again seen in the left centrum semiovale, unchanged from the previous study. A similarly sized right parietal lobe nonenhancing T2 hyperintense lesion without restricted diffusion is also unchanged from the previous study.Patchy enhancing T2 hyperintensity that was present on the previous studies involving the left medial temporal lobe, lateral thalamus and basal ganglia also shows no significant interval change. Single voxel spectroscopy of this lesion demonstrates decreased NAA, decreased choline, and decreased creatine relative to the contralateral normal side. rCBV imaging shows reduced cerebral blood volume correlating to all the above noted lesions.Streaky enhancement in the right parietal lobe is seen in a peri-venular pattern, unchanged. No new signal abnormality or pathologic enhancement is detected. No evidence of hemorrhage, mass effect, or edema is seen. The ventricular size is normal with no midline shift.
1. No change in the appearance of the high T2/FLAIR signal and enhancing lesions in the left temporal lobe, right parietal lobe, and the left centrum semiovale.2. Spectroscopic pattern of the dominant left temporal lesion is compatible with parenchymal injury and argues against an aggressive or highly proliferative neoplastic process.3. There is a reduced cerebral blood volume within the described lesions that also argues against an aggressive neoplastic process.4. Differential diagnosis favors inflammatory or granulomatous conditions such as sarcoidosis or lupus, post inflammatory auto-immune phenomena, and atypical demyelinating disease.