18-year-old with history of seizure and prior right temporal lobe indeterminate lesion/mass. Follow-up exam. There remains abnormally increased T2 signal within the mesial right temporal lobe hippocampus and amygdala which is perhaps minimally decreased compared to prior. The 2 nodular foci of increased enhancement in the right temporal lobe and insula noted on the prior MRI have resolved. There remains diffuse increased sulcal enhancement of the right cerebral cortex and gyriform increased T2 signal of the right cerebral cortex gray matter again likely reflecting a combination of hyperemia and increased sulcal vascular permeability.No areas of focal susceptibility.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The paranasal sinuses are otherwise clear. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. Compared to prior, there is stable to minimally decreased abnormal T2 signal in the mesial right temporal lobe. The adjacent nodular foci of enhancement have resolved. Considering the MR spectroscopy data from 12/15/2015, this remains most consistent with an inflammatory process with tumor considered less likely. Both noninfectious (autoimmune) and infectious (perhaps viral) encephalitis would be in the differential diagnosis.2. Diffusely increased gray matter T2 signal and sulcal/leptomeningeal enhancement in the right cerebral cortex. This may reflect hyperemia and increased sulcal vascular permeability, which could be related to an underlying inflammatory process or which could be secondary to seizure activity.