Diagnosis: Dysarthria and anarthria. Epilepsy, unspecified, not intractable, without status epilepticusClinical question: new strokeSigns and Symptoms: Right side weakness, confusion The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia present in the left temporal lobe involving the posterior aspects of the left middle and superior temporal gyri which extends to the adjacent parietal lobe.There is FLAIR signal hyperintensity within the white matter surrounding the occipital horn of the left lateral ventricle associated with obliteration of the occipital horn. The trigone of the left lateral ventricle is dilated as a result of ex vacuo effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The visualized portions of the paranasal sinuses are grossly clear. The visualized portions of the orbits are grossly intact.Images are degraded by patient motion.
1.Exam is limited due to patient motion which may obscure more subtle abnormalities as well as the patient's inability to complete the exam. If clinically indicated and possible, the use of sedation or anesthesia may help obtain a more complete exam.2.To the extent of visualization there is no acute cerebral infarction identified.3.There is encephalomalacia centered along the left temporal lobe and extending into the left parietal lobe as detailed above.4.There is obliteration of the occipital horn of the left lateral ventricle. The possibility of edema due to an underlying lesion cannot be excluded on this limited exam. Additional imaging may be helpful to further evaluate this.