Left 3rd, 4th and 6th nerve palsy. CT evidence of suprasellar mass. Fiducial markers were attached on the scalp for the purpose of Stealth guidance.There is expansile suprasellar mass (24mm x 34mm x 34mm) which shows slightly inhomogenous iso signal intensity with brain parenchyme on T1 weighted images and slightly high signal intensity on T2 weighted images. On Gad enhancement, there are nodular and linear enhancements especially superior and central part of the mass indicating inhomogenous enhancement. Considering signal voids on Gradient echo images within the center of the mass, the inhomogenous enhancement pattern indicates intra tumoral hemorrhage with some edema.The mass displaces optic chiasm superiorly and extending toward left side cavernous sinus especially middle and posterior aspect displacing cavernous sinus segment of the left ICA laterally indicating possible left cavernous sinus invasion. However, left side cavernous itself shows thin but normal enhancement indicating cavernous sinus itself is patent without evidence of engorged left supra-ophthalmic vein.The differential diagnosis include pituitary macroadenoma with intratumoral hemorrhage most likely, the possibility of craniopharyngioma, meningioma or metastasis is less likely.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Suprasellar mass with inhomogeneous enhancement with possible left cavernous sinus invasion, the likely diagnosis would be pituitary macroadenoma as described above.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.