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Temporal Lobe Cystic Lesions
A 16-year-old boy with “abnormal head computed tomography” after a minor head trauma. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
A 49-year-old man with postconcussive syndrome after a bicycle accident. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
A 50-year-old man with altered mental status. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
A 24-year-old man with adrenoleukodystrophy. DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
DESCRIPTION OF FINDINGS
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Case A: MRI of the brain demonstrates a T2 hyperintense cystic lesion in the left temporal lobe and subinsular region. This lesion is hypointense on FLAIR and DWI, follows CSF signal on all sequences, and does not enhance on postcontrast T1-weighted images. No abnormal signal is noted in the surrounding brain parenchyma.
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Case B: MRI of the brain demonstrates a T2 hyperintense multiseptated cystic lesion in the left mesial and anterior temporal lobe. This lesion is hypointense on FLAIR and DWI, follows CSF signal on all sequences, and does not enhance on postcontrast T1-weighted images. A thin rim of FLAIR hyperintense signal is noted in the surrounding brain parenchyma.
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Case C: MRI of the brain demonstrates a T2 hyperintense cystic lesion in the left mesial temporal lobe that appears to be centered within the choroid fissure on the coronal T1-weighted postcontrast images. This lesion is hypointense on FLAIR and DWI and follows CSF signal on all sequences.
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Case D: MRI of the brain demonstrates a T2 hyperintense cystic lesion in the right superior temporal gyrus with a small apparent tail extending to the adjacent subarachnoid space. This lesion is hypointense on FLAIR and DWI, follows CSF signal on all sequences, and does not enhance on postcontrast T1-weighted imaging. No abnormal signal is noted in the surrounding brain parenchyma.
Diagnosis
Case A
Neuroglial cyst versus arachnoid cyst versus enlarged perivascular space
Case B
Enlarged perivascular space versus neuroglial cyst
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