Reason: Evaluate for source of seizure activity, pt is nonverbal at this time which is significantly different from her baseline History: Nonfocal exam except nonverbal The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a ringlike signal hypointensity present along the medial aspect of the left cerebellar hemisphere measuring 5 mm in diameter. Centrally it is high he is signal and intermediate and T1There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally, there is T2 and flair signal hyperintensity along the brain stem distributed in a patchy manner.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. The left eyeball lens is thin.Incidental note is made of partial empty sella
1.There is a small lesion present in the left cerebellar hemisphere measuring 5 mm in size which is suspected to represent a cerebral cavernous malformation . Susceptibility imaging and contrast enhancement may be helpful in evaluating for associated developmental venous anomaly .2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There are brainstem lesions present which are suspect to be vascular related but are nonspecific.4.Examination was somewhat compromised due to patient inability to cooperate. As a result not all pulse sequences were performed. The susceptibility weighted imaging was not performed. This may result in overlooking more subtle abnormalities.