73-year-old woman with history of seizures and left medial temporal lesion. In the left medial temporal lobe (5/19) there is a 6mm area of low T1 and T2 signal. There is minimal surrounding T2 hyperintensity but no significant mass effect. No clear abnormal vasculature is seen in this region. There is mild susceptibility artifact corresponding to this lesion on diffusion images but, as specific susceptibility weighted images were not obtained on this seizure protocol, the possibility of additional small or subtle susceptibility inducing lesions cannot be excluded.The medial temporal lobes are otherwise normal in size and configuration. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age.Sella and orbits are grossly within normal limits. There is a mucous retention cyst in the left maxillary sinus, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA BRAIN
1. A small, low T1 and T2 signal lesion is evident in the left medial temporal lobe without evidence of significant associated edema or mass effect. The signal characteristics are suggestive of the presence of hemosiderin or perhaps calcification/mineralization. The findings favor a long-standing chronic process and the differential would include a small cavernous malformation, as well as sequelae of prior inflammation or injury. 2. Very small incidental aneurysm of the right PCA origin.3. Mild atherosclerotic disease involving the carotid bifurcations.