Diplopia, structural lesion, brain stem?. Per medical record, patient has history of multiple myeloma. There is lobulated mass involving the sella measuring up to 3.8 x 3.9 x 3.5 cm in the maximal AP, transverse, and craniocaudal dimensions. Pituitary gland and infundibulum are anteriorly displaced. Mild suprasellar extension without significant mass effect on the optic chiasm is appreciated. There is inferior extension into the clivus involving the basisphenoid bone and the sphenoid sinus on the right. Laterally, there is extension into the bilateral cavernous sinuses without evidence of circumferential encasement of the cavernous carotid arteries. Bilateral optic nerves and chiasm are normal in signal. There is mild global parenchymal volume loss including the bilateral cerebellar hemispheres.There is volume loss and surrounding gliosis involving the left parietal lobe likely related to prior cortical infarct. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No mass effect on the brainstem is appreciated. Major flow-voids are preservedRight maxillary mucous retention cyst. There are numerous small enhancing lesions throughout the calvarium consistent with history of multiple myeloma. No associated intracranial mass effect.
1. Lobulated enhancing mass measuring 3.8 x 3.9 x 3.5 cm involving the sella with smooth expansile erosion involving the upper aspect of the clivus and sphenoid sinus. Pituitary gland and infundibulum appear anteriorly displaced. Lesion is favored to be related to multiple myeloma and less likely pituitary adenoma. Laterally there is some extension into the bilateral cavernous sinuses. 2. Multiple small enhancing lesions throughout the calvarium consistent with known multiple myeloma.3. Small chronic left parietal infarct.4. No lesions within the brainstem or mass effect on the brainstem.