Clinical question: Pituitary adenoma. Signs and symptoms: Headache. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate diffuse punctate foci of flair hyperintensity primarily in the subcortical and periventricular white matter of cerebral hemispheres consistent with chronic small vessel ischemic strokes of mild degree. Minimal similar signal changes are noted in basal ganglia and more extensively in the pons as well concerning for chronic microvascular ischemic changes.Tiny foci of flair hyperintensity in the cerebellar hemispheres consistent with prior ischemic strokes.There is a slight prominence of cortical sulci and cerebellar -- vermian folia.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Thin coronal T1 and T2-weighted images through the sella demonstrate a slight thickening along the left lateral aspect of pituitary gland with T2 hyperintensity suggestive of an adenoma. This finding results in subtle deviation of pituitary stalk to the right. There is no convincing evidence of extension of tumor into the cavernous sinus or basal cistern on this nonenhanced dedicated imaging. The finding measures approximately at 8.5 x 5.5-mm and coronal T2 weighted series 1301. Compared to prior exam from 2014 there is no convincing evidence of any appreciable interval change..
1.No acute intracranial process and negative diffusion weighted series.2.Findings of chronic small vessel ischemic strokes as detailed.3.Pituitary microadenoma on the left measuring approximately at 8.5 x 5.5-mm on this nonenhanced exam and without convincing evidence of interval change.