Evaluate for etiology of left temporal lobe seizures. Possible tumor on previous MRI. MRI Brain: There is stable to minimal increase in size of the abnormal increased T2/FLAIR signal and cortical thickening of the anterior and medial left temporal lobe, the left insular cortex and the posterior left thalamus. There is no associated enhancement or restricted diffusion. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are multiple punctate foci susceptibility artifact of the supra- and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhage. At the posterior aspect of the left parotid gland, there is a lobulated T1 hyperintense lesion with incomplete fat suppression on T1 post contrast fat saturation, but with fat attenuation on CT head dated 11/14/12014, may represent a lipoma. The skull and extracranial soft tissues are otherwise unremarkable. MR spectroscopy: Single voxel MR spectroscopy over the thickened, abnormal tissue in the posteromedial left temporal lobe demonstrates an elevated choline peak with decreased NAA peak relative to the contralateral normal side, suspicious for the presence of tumor. Single voxel MR spectroscopy over the abnormal tissue in the left insular cortex is somewhat more indeterminate and demonstrates only mildly elevated choline and decreased NAA relative to the contralateral normal side.MR perfusion: While there is suggestion of elevated relative cerebral blood volume corresponding to the abnormal tissue in the left temporal lobe, suboptimal bolus delivery makes interpretation unreliable.
1. Stable to slightly increased size of abnormal tissue in the anterior and medial left temporal lobe, left insular cortex and posterior left thalamus. 2. The spectroscopic pattern of the left posteromedial temporal lobe component of the lesion is concerning for the presence of tumor.  