Seizure disorder and likely mitochondrial disorder with new focal neuro deficits. Focal right posterior parietal/occipital lobe seizures. There are scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes. There has been interval cavitation of the expanded bilateral medullary olives with associated peripheral enhancement. There are T2 hyperintense lesions in the bilateral thalami, right larger than left. The caudate nuclei appear to be slightly T2 hyperintense diffusely. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right superior frontal gyrus developmental venous anomaly. The ventricles and basal cisterns are 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.
Scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes, persistent abnormalities in the bilateral thalami and basal ganglia, and interval cavitation of the medullary olives. Overall, the findings may represent stigmata of a mitochondrial disease, particularly Leigh and Leigh-like syndromes, with associated seizure activity and hypertrophic olivary degeneration.