Per EPIC, patient with history of Crohn's disease and narcotic dependence has had 4 episodes during which he became unresponsive, though awake, for minutes (20-30?) accompanied by "staring into space." No tonic clonic movements or post-ictal symptoms. Evaluate for seizure focus. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate, confluent and curvilinear areas of T2 hyperintensity in the periventricular and subcortical white matter and left cerebellum, one of which is new at the left subinsular white matter. Focal areas of T2/FLAIR hyperintensity are also noted involving the right amygdala, left frontal subcortical white matter, and the paramedian cortex involving the right superior frontal gyrus. No associated mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the anterior ethmoid air cells.
1. No evidence of intracranial mass or mass effect. 2. Allowing for differences in technique, no significant interval change in scattered periventricular and subcortical white matter T2/FLAIR signal abnormalities, except for a new focus of T2 hyperintensity in the left subinsular white matter. These findings are nonspecific and may be related to prior ischemia or demyelination. There also areas of T2/FLAIR hyperintensity involving the right amygdala, left frontal subcortical white matter, and the paramedian cortex involving the right superior frontal gyrus; these are of uncertain etiology and remain grossly unchanged since 2005. These may also represent sequela of prior injury although remote possibility that these may be related to cortical dysplasia however is not entirely excluded. Given stability since 2005, neoplasm is essentially excluded.