Headache. Pituitary abnormality on CT scan. BRAIN MRI:There is extensive mucosal thickening involving the paranasal sinuses. In addition, there is fluid in the maxillary sinuses. In the appropriate clinical setting, this may reflect sinusitis, which may account for patient's symptoms.Brain demonstrates normal structure and signal. There is no mass. The ventricles and the other CSF-containing spaces are normal in size. There is no abnormal diffusion restriction or susceptibility effect to indicate recent infarct or intracranial hemorrhage. Focal flow void abutting the left internal carotid terminus and indenting the under surface of the anterior aspect of the left putamen, where there is minimal apparent surrounding T2-hyperintense signal, is probably a saccular aneurysm arising from the carotid terminus. The left carotid terminus itself is also mildly dilated compared to the right carotid terminus. While the neck seems to be small, the maximum width of this presumed aneurysm is 4 mm. It is likely 7 mm apex to base. Otherwise, the major intracranial vascular flow voids are preserved, reflecting gross patency.There is no destructive skull lesion. The orbits are normal.PITUITARY MRI:The pituitary gland shows homogeneous contrast enhancement without focal lesion. It is not enlarged. The pituitary infundibulum is of normal thickness and is midline. The cavernous sinuses are also normal.
1.While this study is not optimal for vascular assessment, there is suggestion of a complex appearing 7 mm saccular aneurysm arising from a mildly dilated left internal carotid artery terminus. There is no intracranial hemorrhage. Dedicated cranial MR angiography without contrast is recommended.2.There is extensive mucosal thickening and fluid in the paranasal sinuses. In the proper clinical setting, this may reflect sinusitis, which may account for or contribute to patient's symptoms.3.There is no brain abnormality.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Rita M Rossi-Foulkes over the phone on December 31, 2015 at 1643 hours.