Possible seizure, also with question of HSV encephalitis: AMS, headache prior to admission. There appear to be punctate foci of restricted diffusion in the bilateral superior frontal gyri. There is mild periventricular white matter T2 hyperintensity, but the temporal lobes are spared. There is also numerous scattered foci of susceptibility effect in the right basal ganglia, left periventricular white matter, and more peripherally in the left cerebral hemisphere, which correspond to the calcifications demonstrated on CT. There is mild diffuse cerebral volume loss. 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. However, there is fluid within the bilateral mastoid air cells.
1. Apparent punctate foci of restricted diffusion in the bilateral superior frontal gyri.2. Mild periventricular white matter T2 hyperintensity may represent chronic small vessel disease, but there are no findings specific for herpes encephalitis, although assessment is limited without contrast.3. Numerous scattered calcifications in the bilateral cerebral hemispheres may be related to a prior infection or granulomatous disease.4. Fluid within the bilateral mastoid air cells may represent mastoiditis.