Clinical question: Brain lesion that causes seizure. Signs and symptoms: Staring spells x 5 minute period past medical history of IVH and possible PVL. Unenhanced brain MRI: No diffusion weighted abnormalities.Examination demonstrates extensive bilateral hemispheric periventricular cystic encephalomalacia highly suggestive of PVL. The ventricular system remain within normal size and with maintained midline. There is a slight prominence of cerebral cortical sulci for patient's stated age of 12 and concerning for possible underlying proximal volume loss.There is no detectable signal abnormality of cerebral cortex. There is no detectable congenital anatomical malformation.CSF spaces are unremarkable.There is no evidence of a mass or mass effect. Susceptibility MRI images are negative for any chronic hemorrhagic changes.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal.Calvarium is intact.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Findings consistent with extensive PVL.3.Slight generalized prominence of cortical sulci for age.4.No evidence of a mass or congenital anatomical anomaly of brain to explain patient's seizures.