 There is reconstruction of areas of relatively symmetric T2/FLAIR hyperintensity within the periatrial white matter bilaterally without sparing of the subcortical U fibers, slightly more anteriorly extending on the left into the posterior aspect of the left external capsule. There are areas of transcortical involvement along the occipital lobes. There has been interval progression of associated volume loss with areas of encephalomalacia appearing subcortical regions, with relative sparing of the periventricular white matter. There is again mild ex vacuo dilatation of the atria with respect to the remainder of the lateral ventricles. Otherwise, myelination pattern appears appropriate for stated age in areas of preserved white matter.There is redemonstration of an oval-shaped area of gray matter signal on all sequences measuring opacity 9 x 6 mm along the lateral margin of the posterior body of the right lateral ventricle. This is best appreciated on 201/17 and 601/19.The ventricles and sulci are otherwise within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Major vascular flow voids are preserved.There is moderate fluid opacification of right and mild opacification of the left mastoid air cells. There is scattered mild mucosal thickening in maxillary and ethmoid sinuses.
1. Redemonstration of relatively symmetric T2/FLAIR abnormality within predominantly the subcortical white matter within the cerebral hemispheres posteriorly, although there are small areas of transcortical involvement along the occipital lobes. This again is favored to represent leukomalacia although of uncertain etiology, perhaps relating to a chronic ischemic insult.2. Stable focal subependymal heterotopia along the lateral margin of the right lateral ventricle.