Evaluate for brain lesions. Post fall. Evaluation is limited by motion artifact. There are punctate foci of restricted diffusion within the bilateral cerebellum associated T2/FLAIR hyperintensity and no definite enhancement, probably acute to subacute infarcts. There is a 5.2 x 5.1 x 6.1 cm large enhancing mass, which overall demonstrates mild restricted diffusion and areas of susceptibility representing microhemorrhage, that expands the sella turcica. The optic chiasm is presumably displaced superiorly and compressed not well delineated. Normal pituitary tissue is not identified. The mass encases and laterally displaces the anterior cerebral arteries, and also encircles the cavernous supraclinoid internal carotid arteries by greater than 50%, suggestive of cavernous sinus invasion. There is a mild rim of FLAIR hyperintense vasogenic edema, predominantly within anterior frontal lobes. There is slight truncation of the frontal horns of the lateral ventricles. The third ventricle is mildly prominent and foreshortened likely due to mass effect. The fourth ventricle is normal in size. There is superior displacement of the corpus callosum, with the rostrum not clearly delineated. The suprasellar cistern is obliterated. The remaining basal cisterns are intact.There is a left extra-axial uniformly enhancing mass with dural extension measuring 1.1 x 0.8 cm (series 1301, image 124), probable meningioma. An additional left frontal dural based enhancing mass measures 1.9 x 1.7 cm (series 1301, image 151), and extends within the left precentral sulcus. There is prominence of the right lateral frontal subarachnoid space, with normal traversing vessels visualized. This may relate to asymmetric mass effect from findings in the left hemicranium rather than right-sided volume loss. There is slight increased fluid distention of the distal right optic nerve sheath. Trace fluid is noted in the right mastoid air cells.
1.Large enhancing sellar/suprasellar multilobulated mass containing areas of restricted diffusion and microhemorrhage, expanding the sella turcica, encasing and displacing the anterior cerebral arteries, and invading the cavernous sinus. Significant localized mass effect. Differential diagnosis includes primarily pituitary macroadenoma, versus meningioma and less likely craniopharyngioma. 2.Punctate foci of restricted diffusion within the bilateral cerebellum, consistent with acute to subacute infarcts.3.Enhancing left frontal dural based mass, most compatible with meningiomas.