Medically intractable epilepsy, abnormal CT head. Left temporal seizure, right hemisphere atrophy on CT. There is marked diffuse right cerebral volume loss with ex vacuo dilatation of the right lateral and third ventricles. There is a lesser degree of diffuse left cerebral volume loss. There are mild scattered patchy cerebral white matter T2 hyperintense lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The infratentorial structures are unremarkable, aside from perhaps mild asymmetric left cerebellar volume loss, which maybe due to crosses-cerebellar diaschisis. There is no evidence of intracranial hemorrhage, abnormal intracranial enhancement, or mass. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst and the bilateral frontal sinuses are mildly prominent, right greater than left. There is marked anterior nasal septal deviation.
Right greater than left cerebral atrophy may represent adult-onset Rasmussen encephalitis or sequela of periventricular leukomalacia, perhaps with superimposed volume loss.