MELAS

Multifocal non-enhancing patchy FLAIR hyperintensities without restriction of diffusion involving left temporal lobe, occipital lobe and posteromedial part of left thalamus with elevated lipid – lactate levels – likely suggestive of mitochondrial encephalopathy (MELAS)

Differential considerations also include:- demyelinating disease such as acute disseminated encephalomyelitis (ADEM) versus neuromyelitis optica (NMO) versus atypical viral encephalitis

Focal pachymeningeal enhancement in left temporal lobe

No evidence of significant mass effect or mid line shift.

Recommend clinical correlation, anti MOG ,Aqp4 antibodies, CSF and serum analysis (for lactate), further evaluation, follow up