Focus for new GM seizure. Nocturnal seizures and +ANA. There is a circumscribed 9 x 9 mm round T2 hyperintense focus involving the posterior aspect of the right inferior temporal gyrus. There is associated enhancement. Medial to it is a smaller nodule with T2/FLAIR hyperintensity with mild enhancement suspected on the coronal post gad sequence.Remainder of the brain appears unremarkable with no other areas of abnormal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is asymmetry in size involving the lateral ventricles which is a normal variant. No hydrocephalus. No extra-axial collections. Bone marrow signal is within normal limits. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. There are ovoid enhancing nodules in the occipital scalp, left relatively larger than right measuring up to 18 x 13 mm on the left in the coronal plane. Presumably these represent enhancing lymph nodes.
9 mm cortical/subcortical focus of T2 hyperintensity with enhancement and adjacent more linear focus of T2 hyperintensity involving the right posterior right temporal lobe. Finding may be represent neoplasm such as a ganglioglioma or DNET with associated cortical dysplasia. Infection also remains a possibility especially chronic low-grade infection given absence of surrounding edema. There is an 18 x 13 mm enhancing nodule in the left occipital soft tissues which likely represents a mildly enlarged lymph node and is nonspecific. Unclear if this is related to the right posterior temporal lesion. 