Male, 65 years old, status post seizure with left head deviation and convulsions. A clustering of small T2 hyperintense foci are evident within the inferior right precentral gyrus, involving predominantly the subcortical white matter. The gray matter overlying the affected region blends to some degree with the lesion and, as a result, is somewhat distorted in appearance. On thin section T1-weighted imaging, the lesion or lesions have a somewhat linear or curvilinear morphology suggesting vessels, or a perivascular distribution, or potentially even radial migration lines.No significant associated mass effect is detected. No diffusion restriction or significant susceptibility effect is noted. Elsewhere, brain parenchymal morphology is within normal limits. There are a small number of additional scattered foci of T2 hyperintensity in the cerebral hemispheres which are nonspecific. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology. A subcentimeter nasopharyngeal cyst is detected incidentally. Bone marrow signal characteristics are unremarkable. Mild inflammation of the paranasal sinus mucosa is demonstrated.
A lesion is detected in the right inferior precentral gyrus corresponding to the face/head region of the motor homunculus. The lesion is incompletely characterized without contrast, and as such, the patient should return to receive postcontrast imaging.Given the limited evaluation, the differential diagnosis would include gliosis from some prior insult or injury, a congenital migrational anomaly, or potentially an underlying vascular lesion. A neoplastic etiology is not highly suspected, but postcontrast imaging will help in this regard.