 Again demonstrated is dilatation of the right temporal horn, similar to previous, with volume loss involving the adjacent right parahippocampal gyrus suggesting that right temporal horn enlargement is likely on an ex vacuo basis. There is increased T2 signal in the medial right temporal lobe including hippocampus as well as anterior to the hippocampus. There is increased T2 signal involving the mesial left temporal lobe as well but to a lesser extent. There is some volume loss involving the bilateral hippocampi, but does not appear disproportional to the remainder of the brain.There is a 4 x 5 mm small aneurysm of right anterior communicating artery at A1/A2 junction There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. Incidental note is made of a persistent cavum septa pellucidum and vergae. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.There is mucous retention cyst in the right maxillary sinus. Remaining paranasal sinuses and mastoid air cells are clear.
1. Stable ex vacuo dilatation of the right temporal horn, as well as increased T2 hyperintensity involving the mesial temporal lobes right more than the left. Findings are consistent with gliosis which may be related to prior inflammation, ischemia, trauma, or other injury. No significant change since prior. No intracranial mass or mass effect. No abnormal enhancement.2. 5 x 4 mm right anterior communicating artery aneurysm incidentally noted.3. Periventricular and subcortical T2 hyperintensities likely related to chronic small vessel ischemic disease.