59-year-old female with intractable complex partial seizures, without status epilepticus. There is mildly increased T2/FLAIR signal involving the bilateral hippocampi. The left hippocampus is asymmetrically smaller. The internal architecture of both hippocampi is grossly preserved within the limits of technique. No gray matter heterotopia, cortical dysplasia, or other lesion to suggest seizure focus is appreciated. A small focus of volume loss in the posterior right cerebellar hemisphere may relate to tiny remote infarct. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with very mild chronic small vessel ischemic changes. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No abnormal enhancement. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Empty sella which is expanded is incidentally noted. The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
Nonspecific findings in the bilateral hippocampi as described above, raising question of mesial temporal sclerosis. No additional findings to suggest seizure focus. Consider high resolution coronal T2/FLAIR sequences at 3 Tesla.