Clinical question: 23-year-old male with worsening migraines, weight loss and abnormal tft's. Signs and symptoms: Worsening migraines. Pre and post enhanced pituitary MRI:The pituitary gland demonstrate normal size, signal intensity and morphology and with normal pattern of enhancement. The pituitary stalk demonstrate normal signal intensity and pattern of enhancement. No detectable abnormality of the hypothalamic region.Right lateral cavernous sinuses are well visualized and unremarkable.Images through the skull base are unremarkable and the paranasal sinuses remain well pneumatized.Pre and post enhanced brain MRI:Diffusion weighted images are unremarkable.Examination demonstrates normal anatomical developmental brain and normal signal intensity on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post contrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no abnormal enhancement of calvarium or the retro-orbital spaces. Normal pattern of enhancement of the intracranial venous sinuses.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern is.
1.Negative pre and post enhanced brain MRI.2.Negative pre and post enhanced pituitary MRI.3.Normal pneumatization of all paranasal sinuses and bilateral mastoid air cells and cavities.