 MRI Brain: Motion degraded examination.There is restricted diffusion involving the posterior limb of the left internal capsule extending into the left cerebral peduncle as well as involving the left periventricular white matter compatible with an acute infarct. Small additional chronic lacunar infarcts are noted along the superolateral aspect of the thalamus on the right. There is T1 shortening involving the right basal ganglia with suggestion of enhancement which may reflect subacute ischemia or metabolic injury.Enhancing mass involving the right aspect of the sella measures approximately 2.4 x 2.3 cm (series 1702, image 119). The mass extends into the right cavernous sinus and encases the cavernous segment of the right internal carotid artery. It also abuts the bifurcation of the right internal carotid artery. The pituitary infundibulum is displaced leftward. Enhancing tissue along the left aspect of the sella is compatible with residual pituitary tissue. There is mild effacement of the lateral aspect of the suprasellar cistern on the right, however, there is no mass effect on the optic chiasm.There is suggestion of prior surgery involving the sella with focal defect along the anterior aspect of the sella. Correlation with history is suggested. Tiny (~5 mm) meningioma is present along the anterior aspect of the falx abutting the inferior frontal lobe without significant mass effect.There is no midline shift or herniation. No hydrocephalus. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the paranasal sinuses most notably in the right maxillary sinus. The midline structures and craniocervical junction are within normal limits. MRA Head: Markedly motion degraded examination without evidence of high-grade stenosis.The intracranial internal carotid arteries are patent and demonstrate no significant stenosis. The sellar mass encases the cavernous segment of the right internal carotid artery and abuts the bifurcation. The middle and anterior cerebral arteries are also patent. The vertebral basilar artery system is diminutive, at least predominant due to developmental variant with prominent posterior communicating arteries and diminutive P1 segments. There are focal areas of signal loss along the bilateral posterior cerebral arteries which are likely artifactual with better visualization on the postcontrast MRI. No evidence of aneurysms or vascular malformations within the limits of motion degradation.
1. Acute infarct involving the posterior limb the left internal capsule, left cerebral peduncle, and the left periventricular white matter.2. T1 shortening in the right basal ganglia with suggestion of enhancement may reflect subacute ischemia versus metabolic injury (such as non-ketotic hyperglycemia).3. Enhancing mass involving the right aspect of the sella with extension into the right cavernous sinus and encasement of the cavernous segment of the right internal carotid artery. Overall findings likely reflect residual or recurrent pituitary macroadenoma.4. Moderate chronic small vessel ischemic disease.5. Motion degraded MRA without evidence of high-grade stenosis.The above findings were communicated via telephone to Fabiane Santos de Lima at 11:00 AM on 10/18/16. 