73-year-old female with seizure history presenting with seizure activity and an abnormal EEG with sharp waves noted over the left fronto-temporal area; further evaluation of this area requested. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There has been minimal progression of the mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic changes. This subtle signal intensity within the pons is redemonstrated and unchanged. Again seen is a empty sella with remodeling. There is also some minimal increase in the sulci and ventricle sizes which may be related to global cerebral atrophy. The left hippocampus appears to be smaller than the right side. The signal intensity of the left hippocampus seems to be slightly increased than that of the right side indicating possible hippocampal sclerosis. On prior exam, the left hippocampus appeared to be smaller than that of the right side, however, since that study was not dedicated hippocampus scan, thus, cannot draw any firm conclusion at that point. In addition, it is hard to assess any progression of the left hippocampal signal intensity or size of the left hippocampus comparing to prior scan. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Smaller left hippocampus compared to the right with subtle higher signal intensity than the right side, indicates possible left hippocampal sclerosis. 3.No additional findings are seen elsewhere to indicate a seizure focus.4.Minimal progression of the likely chronic small vessel ischemic changes.