Clinical question: Evaluate for etiology of seizure. Signs and symptoms: Suspected seizures, as is right temporal and parietal hypodensities on CT. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a chronic healed depressed right parietal calvarial fracture as was noted on prior head CT. There is a small focus of underlying cortical and subcortical hemorrhagic encephalomalacia of the right parietal lobe. This finding measures approximately at 19 times 15-mm in largest transaxial dimensions.Additionally there is a larger focus of encephalomalacia in the inferior aspect of right anterior/mid temporal lobe confined primarily to the periventricular white matter of right temporal and extending inferiorly to the cortex. There is no evidence of hemorrhagic changes with this finding. It measures at least at 27 x 19 x 19-mm in size. There is mild ex vacuo dilatation of right temporal horn. This findings are best appreciated on coronal T2 and flair series 901 and 1001. The anatomical morphology of the brain is otherwise within normal and with normal signal intensity on all MRI sequences. The ventricular system and disuse of the spaces remain within normal and with maintained midline. The signal void of major intracranial arterial branches are identified and unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate a single retention cyst in the dependent portion of the left maxillary sinus and unremarkable otherwise.
1.No acute intracranial process.2.Small focus of right parietal superficial hemorrhagic encephalomalacia under a chronic healed depressed skull fracture as detailed.3.Larger focus of nonhemorrhagic encephalomalacia along the inferior surface of right anterior/mid temporal lobe involving the white matter and the cortex. Finding results in mild expansion of right temporal horn. 4.Unremarkable pre-and post enhanced brain MRI otherwise.