Clinical question: Rule out intracranial lesion, evaluate for bitemporal visual field cut and pale optic disc and blurry vision. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Unremarkable diffusion-weighted images.Examination demonstrate a small focus of FLAIR hyperintensity in the right centrum semiovale measuring 7 x 8 mm in transaxial dimensions. Finding is without detectable susceptibility signal changes or enhancement.Small well demarcated focus of FLAIR and T2 hyperintensity is noted in the right cerebral peduncle measuring 5 x 5 mm in transaxial dimensions. This finding also demonstrate no associated susceptibility signal changes or enhancement and no detectable mass effect.There is a very poorly defined small focus of FLAIR/T2 hyperintensity in the subcortical white matter of left posterior frontal lobe (axial FLAIR and T2 image 11) with subtle enhancement and measuring at approximately 8 mm in transaxial dimensions. The finding demonstrates faint enhanced (coronal post enhanced series 11 image 17 and axial post enhanced series 19 image 12).Post enhanced images demonstrate a small linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches. The enhancement is nonspecific and could represent an intravascular enhancement due to distal occlusion and lacunar infarct. Lack of any visible vasculature and susceptibility MR images precludes possibility of a developmental venous anomaly however this possibility cannot be entirely excluded. Additionally examination demonstrate a well demarcated uniformly enhancing focus immediately anterior to the temporal horn of left lateral ventricle measuring at 6 x 7 mm in transaxial dimensions. This finding demonstrate no signal abnormality on any other MRI sequence and cannot be detected with certainty. This is a nonspecific finding however possibilities of an occult arteriovenous malformation, demyelinating plaque or remote possibility of a metastatic disease cannot be entirely excluded.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium is intact and without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized however a small retention cyst in the left maxillary sinus is noted.Pre- and post enhanced pituitary MRI:There is normal anatomical morphology, signal intensity, size and pattern of enhancement of pituitary gland, pituitary stalk and bilateral cavernous sinuses without evidence of mass. Unremarkable images through the basal cistern and hypothalamic region without abnormal mass or enhancement. Unremarkable images through the paranasal sinuses and skull base.
1.Pre- and post enhanced pituitary MRI is unremarkable.2.Pre and post enhanced brain MRI demonstrate 2 small foci of FLAIR hyperintensity in the right centrum semiovale and right cerebral peduncle without enhancement. Small focus of FLAIR hyperintensity in subcortical white matter of right posterior frontal lobe with faint enhancement measuring 5 mm in transaxial dimensions. Focus of well demarcated enhancement measuring 6 x 7 mm anterior to the tip of the left temporal horn which cannot be identified on any other MRI sequence as detailed. Faint focus of enhancement in the left frontal subcortical white matter with subtle FLAIR/T2 hyperintensity as detailed. Constellation of findings are confusing as some are detectable on FLAIR and T2 weighted series with enhancement and some demonstrate enhancement without any detectable FLAIR/T2 signal changes. Considering patient's age and symptomatology demyelinating disease should be considered. Correlate with history and risk factors is recommended since possibility of small vessel ischemic strokes although unusual for age cannot be entirely excluded. Please review detailed report above.3.A linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches is noted. Possibilities of a nonspecific finding, an intravascular enhancement secondary to distal vascular occlusion/lacunar infarct or a developmental venous anomaly should be considered.