Steroid responsive, waxing-waning encephalopathy. Additional clinical history from electronic medical records: Past medical history significant for right hemiparesis/right hemianesthesia following gunshot wound sustained combat in 1969. Subsequently, the patient developed seizure disorder and is on multiple antiepileptic medications. He also carries the diagnosis of steroid responsive autoimmune encephalitis. Underneath a superior left frontoparietal craniectomy defect, there is cystic lesion with minimal bulging of the bran parenchyma. There is also adjacent white-matter T2-hyperintensity. There is no associated mass-effect, no midline shift or brain herniation. Otherwise, there are a few punctate T2 hyperintense foci in the frontal white-matter bilaterally. There is no acute infarct or intracranial hemorrhage, accounting for foci of susceptibility artifact at the site of previous surgery. There is a background of mild diffuse cerebral volume loss. There is no abnormal parenchymal or leptomeningeal contrast enhancement. The major vascular flow voids are preserved, accounting for a small/hypoplastic right vertebral artery. There is a right orbital fracture with inferior bulging of the orbital fat but no fat stranding or hemorrhage. The orbits are grossly unremarkable otherwise.
1.Left frontoparietal cystic lesion and superimposed surgical alterations may represent remote injury manifesting as cystic encephalomalacia and gliosis. Underlying neoplasm is a potential consideration, although no discrete enhancing mass is identified.2.Punctate T2-hyperintensity in the frontal white-matter is very nonspecific and may reflect chronic microvascular ischemia.3.Chronic right orbital floor blowout fracture.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.