Migraine, left sided numbness, and blurriness of vision. There is a punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. There is a 20 mm wide arachnoid cyst in the middle cranial fossa with flattening of the anterior left temporal lobe. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in a posterior left ethmoid air cell.
1. A punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe may represent a recent "migrainous stroke" or embolic infarct or perhaps an atypical focus of demyelinating disease or incipient neoplasm, for example. Follow up via a brain MRI with contrast may be useful.2. Left middle cranial fossa arachnoid cyst.