11-year-old male presents with a first time seizure, evaluate for structural abnormality. There is no evidence of a mass or acute infarct. There is a focus of encephalomalacia in the left posterior occipital lobe with cortical hemosiderin deposition causing blooming artifact on susceptibility weighted images. No additional hemorrhagic foci are identified. There is no associated vasogenic edema. The ventricles and basal cisterns are normal in size and configuration. The mesial temporal lobes are normal in configuration and signal intensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Single focus of encephalomalacia in the left occipital lobe with cortical hemosiderin deposition. Differential considerations include chronic focal cortical prior hemorrhage from other causes such as cortical venous thrombosis and conceivably an underlying vascular malformation. Acute process is unlikely since there is no evidence of surrounding brain parenchymal edema.Underlying neoplasm is considered less likely given the lack of mass effect. 2. No additional hemorrhagic foci are identified. For further characterization, post-contrast sequences are recommended.