 There is redemonstration of mild thickening and T2/FLAIR hyperintensity involving the cortex of bilateral insula, mesial temporal lobes, and anterior cingulate gyri right greater than left which has been seen on multiple prior studies. The degree of FLAIR hyperintensity however is less conspicuous than prior study.The right amygdala in particular demonstrates asymmetric increase in fullness compared to the left. There is blurring of the internal architecture involving the bilateral hippocampi, which can be better visualized on 3 Tesla. Hippocampal volumes are grossly maintained.The ventricles and sulci are mildly prominent, perhaps slightly advanced for age, but there is no evidence of hydrocephalus. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures are within normal limits. Unchanged appearance of the cerebellar tonsils which are borderline low, right greater than left without clear evidence of Chiari I. Moderate right and trace left mucosal thickening in the maxillary sinuses. The mastoid air cells are clear. Unchanged appearance of small cyst in the midline nasopharynx which may represent mucosal retention cyst or Thornwaldt cyst.
As seen on multiple prior studies dating back to 7/27/2010, there is mild thickening and FLAIR hyperintensity involving the limbic structures including the medial temporal lobes, insula, and anterior cingulate gyri, right greater than left. The degree of FLAIR hyperintensity appears less prominent, perhaps related to technique. These findings may represent sequela of prior limbic encephalitis.