Increased seizure activity, rule out acute pathology. Neck pain. Brain: There are postsurgical changes of right-sided craniotomy including resection of the right anterior temporal lobe. There is T2/FLAIR hyperintensity surrounding the resection cavity consistent with gliosis. There is ex vacuo dilatation of the right temporal horn. There is an additional area of FLAIR hyperintensity and volume loss compatible with encephalomalacia in the right frontal lobe including primarily the right middle frontal gyrus and extending to the right frontal periventricular white matter.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Several punctate foci of FLAIR hyperintensity are noted in the right superior frontal gyrus which may also represent chronic infarcts. There is severely diminished flow-void involving the visualized right upper cervical, petrous and cavernous internal carotid arteries with improved flow-void of the right supraclinoid ICA and its branches, which may be related to collateral flow.No restricted diffusion to suggest acute ischemia. Punctate focus of diffusion hyperintensity seen in the right anterior frontal lobe without corresponding ADC abnormality. No intracranial mass or mass-effect. No hydrocephalus. Mild mucosal thickening is noted throughout the paranasal sinuses. Bone marrow signal within normal limits.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.The cervical spinal canal appears mildly narrow on a congenital basis with superimposed minimal degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing relatively worse on the left related to uncovertebral hypertrophy and mild facet arthropathy.C4-5: No significant compromise to the spinal canal. Minimal left foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow-void is diminutive which may be related to hypoplasia and/or proximal stenosis. Paraspinous soft tissue structures appear within normal limits.
1. Postsurgical changes involving the right anterior temporal lobe, presumably related to epilepsy surgery. There is gliosis surrounding the right anterior temporal resection cavity.2. Encephalomalacia in the right frontal lobe suspected to be related to chronic infarct. No evidence of acute infarct. Punctate focus of mild diffusion hyperintensity seen in the right anterior frontal lobe (image 250) with corresponding FLAIR hyperintensity and without corresponding ADC abnormality; finding may represent a punctate subacute infarct.3. Severely diminished flow-void is seen involving the right upper cervical, petrous and cavernous segments of the internal carotid artery which may be related to occlusion or high-grade proximal stenosis. Consider dedicated MRA or CTA evaluation to better assess the vasculature. 4. No intracranial mass or mass effect.5. Mild congenital narrowing of the cervical spinal canal with superimposed mild degenerative changes as detailed above. No high-grade spinal canal or neural foraminal stenosis at any level is appreciated. No cord signal abnormality.