Female, 84 years old, with altered mental status. A lobular, homogeneously enhancing extra-axial mass is present encroaching on the left frontal lobe with a base of attachment along the left pterion and sphenoid wing. The lesion measures up to 55 x 45 x 30 mm.The lesion induces relatively modest vasogenic edema in the surrounding frontal lobe parenchyma. However, the lesion does produce significant mass effect with effacement of the left frontal horn, posterior displacement and compression of the left basal ganglia, regional sulcal effacement and midline shift to the right. The left aspect of the suprasellar cistern is partially effaced. However, no other evidence of frank brain herniation is seen.The pituitary gland is somewhat dysmorphic with questionable thickening and enhancement along the left sella and cavernous sinus. No additional enhancing lesions are seen. No findings to suggest acute ischemia are demonstrated. Extensive confluent periventricular and scattered juxtacortical FLAIR hyperintense foci are demonstrated. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. Apart from effacement of the left frontal horn, the ventricular system is unremarkable.
1.Findings are seen most suggestive of a large left sphenoid wing meningioma.2.Questionable thickening along the left aspect of the sella and cavernous sinus could represent an additional pituitary or sellar lesion. However, this area is not adequately visualized on the present study. If clinical concern warrants, dedicated pituitary imaging can be considered.3.Extensive white matter FLAIR hyperintensity is seen which statistically most likely represents chronic microvascular ischemic disease.