76 years Female (DOB:4/8/1940)Reason: eval pituitary mass History: strokePROVIDER/ATTENDING NAME: ANUBHA C GANJOO ANUBHA C GANJOO MRI of the brainThere is diffusion restriction present along the corpus callosum including the genu of the corpus callosum in the body of the corpus callosum eccentric to the left side. There is associated T2 and FLAIR signal ofA small focus of encephalomalacia in the left precentral gyrus..The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate opacification of the left maxillary sinus with a T2 hypointense lesion in the infundibulum of the left maxillary sinus extending into the left hiatus semilunaris. There is associated loss of volume within the left maxillary sinus and thickening of the walls of the left maxillary sinus. There is also mild mucosal thickening in the sphenoid sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded due to patient motion which can obscure more subtle abnormalities.MRI pituitary:There is redemonstration of a 25 x 21 mm sagittal dimension T1 hyperintense mass centered in the sella which extends into the suprasellar cistern This mass has heterogeneous signal on T2 and has not changed significantly since the previous exam. The optic chiasm drapes over the mass. The mass abuts the internal carotid arteries bilaterally. The left internal carotid artery appears narrowed.MRA brain:There is 70% stenosis present along the distal left internal carotid artery along the ophthalmic segment between the pituitary mass in the anterior clinoid. There is a 1 mm x 1.5 mm aneurysm at the ophthalmic segment of the right internal carotid artery which is directed medially.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.There is a large pituitary mass with suprasellar extension which displaces the optic high as in an internal carotid arteries.2.There is an acute infarction present along the corpus callosum.3.There is 70% stenosis present at the ophthalmic segment of the left internal carotid artery adjacent to the pituitary mass.4.Small focus of encephalomalacia is present along the left precentral gyrus5.Findings are compatible with an obstructive lesion at the left maxillary sinus antrum and hiatus semilunaris. The possibility of the obstructing lesion cannot be excluded. There additional findings suggestive of silent sinus syndrome and chronic sinusitis involving the left maxillary sinus.6.Some of the images are degraded due to motion artifact.