Pre and post contrast T1 sequences with perfusion and spectroscopy performed to complete characterisation of the cortical and subcortical T2 hyperintensity in the left posterior frontal lobe and involving pre and postcentral gyrus.
This demonstrated nonspecific smooth thin dural enhancement, but no parenchymal or leptomeningeal enhancement.
Although morphologic appearance of signal change could be explained by subacute ischaemia, the absence of gyriform enhancement and the clinical history of onset would be quite unusual.
MR spectroscopy has a wandering baseline, but there is no large lactate peak.
The postcentral gyrus signal change also extends slightly further medially than is typical for MCA territory.No perfusion abnormality identified.
Conclusion: There are several features which cast doubt on a diagnosis of subacute ischaemia, with the main alternative differential being low grade glioma.
A follow-up MRI in 4 to 6 weeks would be helpful to look for temporal evolution.