Other abnormalities of gait and mobility [R26.89] / Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7], Reason for Study: ^Reason: balance issues, pituitary mass History: balance issues, hx of pituitary adenoma There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 9 mm sized enhancing lesion with the surrounding FLAIR high signal intensity at the left temporo-occipital lobe. There is no other enhancing lesion on this scan. MR characteristics of this lesion is non specific. The differential diagnosis include demyelination, inflammation, tumorous condition or subacute ischemic lesion. Follow up imaging study including MR spectroscopy can be considered.There is disproportional volume loss of pons, medullar, bilateral middle cerebellar peduncle as well as bilateral cerebellar hemispheres comparing to supratentorial structures. There is no abnormal enhancement, nor abnormal signal intensity on Gradient echo images. These findings suggest possible diagnosis of multiple system atrophy. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral maxillary sinuses and ethmoid sinuses.
1. Abnormal enhancing lesion with surrounding edema at the left temporo-occipital lobe as described above. Differential diagnosis include demyelination, inflammatory, tumorous and subacute ischemic lesion.2. Possible diagnosis of multiple system atrophy.