Diagnosis: Unspecified disorder of the pituitary gland and its hypothalamic controlClinical question: s/p pituitary adenoma resection on 7/16/15Signs and Symptoms: Post-op surveillance, visual symptoms MRI brain:The patient is status post right frontal craniotomy. There is an extra-axial collection redemonstrated at the craniotomy site which measures up to 5 mm in thickness and previously measured approximately the same.There are punctate foci of diffusion restriction present in the right occipital lobe gray matter and along the left medial thalamus.The right vertebral artery flow-void appears to be diminished. There is a prior MRA exam from 7/11/2015 which indicates potential occlusion of the extracranial distal right vertebral arteryThere is a small focus of encephalomalacia involving the medial aspect of the right orbital gyrus and the gyrus rectus with associated T2 signal hyperintensity and FLAIR signal hyperintensity but without any significant contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple punctate T2 and FLAIR hyperintense foci within the brain stemThere is susceptibility effect along the surface of the cerebellum and the brainstemThere is redemonstration of subdural effusion bilaterally and in the posterior fossa.The patient is status post pituitary fossa and suprasellar mass resection.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are demonstrated mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI pituitary:The patient status post pituitary fossa surgery. There is a residual lesion present within the pituitary fossa which measures approximately 17 x 25 mm in coronal dimensions. It has heterogeneous signal on both T1 and T2. It displays a thin rim of enhancement along its periphery as well as some mild heterogeneous enhancement centrally. Coronal dimensions on the prior exam were approximately 27 x 25 mm. The mass bulges into the inferior aspects of the cavernous sinus bilaterally
1.Since the prior exam postoperative changes located within the pituitary fossa have mildly regressed. The possibility that there may be some residual tumor within the pituitary fossa is suspected. A follow-up exam may help further assess this.2.There are couple punctate foci suspicious for acute or subacute microinfarcts located in the right occipital lobe and the left thalamus.3.Findings suggesting steno-occlusive disease the right distal vertebral artery.4.A focus of encephalomalacia in the right frontal lobe is stable.5.There are subdural effusions present which are stable compared to the prior exam6.There is superficial siderosis present probably related to prior subarachnoid blood7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 