12 years, Male, daily episodes of visual "black-out" and hearing "vibration" in his ears, and headaches. Differential dx include migraine vs. seizures vs. Chiari malformation Examination is moderately motion degraded which may obscure small lesions. Brain parenchyma appears however grossly unremarkable. There is no intracranial mass or mass-effect. No findings to suggest seizure focus are definitively appreciated. There is nodular/bulging contour along the posterior aspect of the left lateral ventricle with FLAIR signal grossly similar to the adjacent white matter. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. There is T2 hyperintensity along the right lateral aspect of the sphenoid sinus which is not well assessed but presumably represents a small mucous retention cyst. Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. Brain parenchyma appears grossly unremarkable. Note there is moderate motion degradation on the current study which may obscure subtle lesions. There is no evidence of Chiari malformation, as questioned.2. Subtle nodular contour irregularity along the posterior aspect of the left lateral ventricle which is favored to be related to asymmetric bulging of the white matter and less likely subependymal heterotopia. If seizures remain in the differential, consider repeat study.