Seizures and pituitary lesion. Per EPIC: supratherapeutic dilantin, hyperammonia from VPA; Possible toxic-metabolic component: pending workup; Paraneoplastic panel negative; LP negative for infection. Pituitary: There is an intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.Brain: There is diffuse T2 hyperintensity of the hippocampi. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial heterotopia, hemorrhage, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable retention cyst in the adenoids. There is a small hemangioma in the left parietal calvarium.
1. An intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm likely represents a Rathke cleft cyst. 2. Diffuse T2 hyperintensity of the hippocampi likely represents vasogenic edema, which can be a result of a toxic-metabolic process, such as hyperammonemia, for example.