Reason: pit tumor bleed History: right hemianopsia MRI brain:Since the prior exam a sellar and suprasellar mass has enlarged. Previously measured 14 x 35 mm and coronal dimensions and currently measures 23 x 43 mm coronal dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.MRI pituitary:Since the prior exam a sellar and suprasellar mass has enlarged. Previously measured 14 x 35 mm and coronal dimensions and currently measures 23 x 43 mm coronal dimensions. Is superior aspect there is T1 signal hyperintensity present on the current exam which was not present on the prior exam. This suggests some associated hemorrhage. This mass extends into the left cavernous sinus and surrounds the left carotid artery appeared superiorly it displaces the anterior cerebral arteries and optic chiasm superiorly. It insinuates itself into the interhemispheric fissure and abuts and displaces the adjacent right frontal lobe including the right gyrus rectus and olfactory trigone. The right A1 segment is located behind the mass.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right and to a lesser degree left anterior cerebral arteries are displaced by the patient suprasellar mass. The right A1 segment courses behind the mass. The A2 segments are along the medial aspect of the patient's suprasellar massThere is no evidence for intracranial aneurysm or cerebrovascular occlusion.
1.Since the prior exam the patient's sellar and suprasellar mass has enlarged and has developed hemorrhage along its superior aspect. The mass surrounds the structures within the left cavernous sinus and displaces the optic chiasm, the right gyrus rectus and olfactory trigone and anterior cerebral arteries right more than left.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 