Clinical question: Mass? Mesial temporal sclerosis. Signs and symptoms: Syncope and shaking. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered small varying size foci of FLAIR and T2 hyperintensity extensively in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres. None of specific, nonhemorrhagic and nonenhancing. The appearance is highly suggestive of chronic small vessel ischemic strokes as was noted on prior head CT. There is a slight prominence of cortical sulci and the lateral ventricles patient's stated age which could be as a result of small vessel ischemic strokes. There is no detectable abnormal parenchymal or meningeal enhancement.Examination is performed utilizing routine brain MRI protocol and without coronal FLAIR series. Within this limitation however there is suggestion of FLAIR/T2 hyperintensity and T1 hypointensity along the medial aspect of the left anterior temporal lobe without suggestion of parenchymal volume loss. Finding is highly suspected medial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for better assessment. Unremarkable images through the orbits including axial fat sat post enhanced series.Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.There are no prior MRI exams for comparison however if such studies are available and provided to the radiology department an addendum to this report will be submitted after comparison.
1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes primarily within the subcortical and periventricular white.3.No abnormal enhancement is detected.4.Increased T2/FLAIR signal intensity of the medial aspect of the left anterior temporal lobe without parenchymal volume loss suspected for mesial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for further assessment/confirmation.