Epilepsy. Hallucinations and altered mental status. History of left temporal lobe laser ablation for epilepsy. There are post treatment changes related to left hippocampal ablation with associated rim of restricted diffusion. There is also peripheral susceptibility and patchy intrinsic T1 hyperintensity along the ablation cavity, compatible with expected postoperative blood products. There is prominent associated T2/FLAIR hyperintensity. Evidence of trepanation within the left temporal and bilateral occipital bones is again noted, with conspicuous enhancement and T2/FLAIR hyperintensity along the peripheral bilateral occipital and left temporal sites of prior depth electrodes. Faint enhancement is seen along the electrode tracts.There is slight asymmetry of the lateral ventricles left greater than right side, unchanged. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.
Expected postoperative findings post left hippocampal ablation, with enhancement and FLAIR parenchymal changes surrounding the ablation site. Additional enhancement and T2/FLAIR hyperintensity along the bilateral occipital and left temporal depth electrode insertion sites.