Reason: evaluate any changes of right temporal lobe History: cognitive decline, slurred speech and nocturnal seizures. MRI brain:Again seen is volume loss of the right anterior and medial temporal lobe, including the right hippocampus, appearing similar to the prior exam. Subtle increased FLAIR signal in the mesial temporal lobes is unchanged. A small focus of intrinsic T1 shortening without susceptibility may reflects mineralization or laminar necrosis from prior injury. No associated abnormal enhancement, susceptibility or restricted diffusion is seen in this region or throughout the remaining parenchyma. There is ex vacuo dilatation of the right temporal horn. The ventricles and basal cisterns are otherwise normal in size and configuration. 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.MRA/MRV brain:No flow limiting stenosis or aneurysms in the anterior or posterior circulation. The vertebral basilar system is patent. There is an incidental extracranial origin of the left PICA. The dural sinuses are patent. The left transverse sinus is diminutive relative to the right, likely reflecting dominance of the right side.
1.Right temporal lobe volume loss particularly involving the right anterior and medial temporal lobes including the hippocampus is not significantly changed. There is focal area of intrinsic T1 hyperintensity which is also unchanged. Subtle FLAIR hyperintensity in the right medial temporal lobe and possibly the left medial temporal lobe also appears similar to prior. Overall findings are favored to represent sequela of prior inflammation, infection, or other injury. No abnormal enhancement to suggest an active inflammatory process.2.MRA is within normal limits without evidence of stenosis.3.MR venogram is within normal limits without evidence of thrombosis.