Partial complex seizure. Headaches. Previous MRI showed T2-hyperintensity of the left amygdala. Video EEG did not show epileptiform or post-ictal activity. There is an apparent subtle increase in T2/FLAIR signal involving the left hippocampus, amygdala and insular cortex on axial imaging and to lesser extent also on the coronal imaging, although overall there are other areas on the left which appear increased in signal diffusely, with relatively lower signal in right-sided structures. There is no definite associated left-sided volume loss or architectural distortion. Previous increased thickening of structures on the left is not apparent on the current exam, and likely related to slice selection. Focal T2/FLAIR hyperintensity in the anterior left subinsular white-matter at the level of the anterior commissure may represent dilated perivascular spaces with associated minimal gliosis. The remainder of the brain is unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, sinuses, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses which is nonspecific. There are prominent lymph nodes in the upper neck, including the nodes of Rouvière, which is a common, probably reactive phenomenon in this age group.
1.An apparent increase in T2/FLAIR signal involving the left hippocampus, amygdala and insular cortex on axial imaging but not on coronal imaging and without associated volume loss or architectural distortion is favored to represent artifact given more extensive left-sided high signal as compared to right when narrowly windowed. Previous left amygdala thickening is not appreciated, likely artifactual.2.Focal T2 FLAIR hyperintensity in the left subinsular region is most suggestive of dilated perivascular spaces with associated minimal gliosis. There is no other abnormality of the brain.