Headache. New tinnitus and hearing loss. The moderate patchy subcortical and deep white-matter T2/FLAIR hyperintensities have very minimally, if any, increased since the previous examination. Similarly, the pontine T2/FLAIR hyperintense foci are unchanged to very minimally increased. The ventricles remain mildly enlarged. There is no midline shift or brain herniation. There is no mass-effect. Major intracranial vascular flow voids are preserved. The small aneurysm arising off the posterior communicating segment of the left internal carotid artery is not adequately assessed on the current examination. Also, while there is no large cerebellopontine angle mass, the study is suboptimal for assessment of the internal auditory canals.The well-circumscribed T1/T2-hyperintense lesion involving the left posterior skull is unchanged and likely represent a benign lesion.The mastoid air cells are clear. There is mild mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality.The heterogeneous lesion with foci of T1-hypointense, T2-hyperintense signal (cystic change) that involves the sella turcica with extension into the right cavernous sinus has not significantly changed since the previous examination. However, this study is not optimized for pituitary assessment.
1.Since 2013, there has been only minimal, if any, increase in the overall moderate burden of cerebral and brainstem white-matter lesions, which may reflect vasculopathy or microvascular disease. 2.The heterogeneous sellar mass with right cavernous sinus involvement is also not significantly changed. If further assessment is clinically warranted, a dedicated pituitary MRI without and with intravenous contrast recommended.