How to diagnose epileptic seizures in a 21-year-old man through imaging?

*Only for medical professionals to read for reference.
Differential diagnosis is not simple.
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The patient is male, 21 years old, with partial complex seizures
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Look at the image below, what do you consider the patient’s diagnosis? ---Answer dividing line---Are you sure you want to see the answer? ▌ Image analysis A.
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0T MR coronal FLAIR image shows that the right hippocampus is smaller than the left, and the normal internal gray matter is unclear
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The ipsilateral fornix is ​​smaller than the normal left fornix
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B.
The coronal T2-weighted image shows that the hippocampus is reduced in size and the normal internal structure is blurred, but the signal strength is normal
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FLAIR sequence can better show signal increase
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 ▌ Imaging diagnosis of medial temporal lobe sclerosis
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 ▌ Differential diagnosis 1.
Status epilepticus; 2.
Low-grade astrocytoma; 3.
Choroidal fissure cyst; 4.
Residual hippocampal sulcus
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 ▌ The main features of the image: abnormally high signal on T2, the hippocampus becomes smaller/shrinked, and the internal structure is unclear
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Secondary signs: atrophy of the ipsilateral fornix and papillary body, enlargement of the temporal horn of the ipsilateral ventricle and choroidal fissure
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DWI high signal (T2 transmission effect)
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Magnetic resonance spectroscopy analysis sees: the choline spike increased, and the NAA spike decreased
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References: [1] Quan Guanmin.
Interpretation of CT and MRI images of the nervous system [M].
People's Medical Publishing House, 2011.
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