Diagnosis: Dizziness and giddinessClinical question: Evaluate for etiology of vertigo and nystagmusSigns and Symptoms: Vertigo and nystagmus The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a 5 x 4 mm T1 hyperintense focus present within the left half of the pituitary gland posteriorly which does not enhance following gadolinium administration.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.
A small lesion within the pituitary gland is suspected to represent a Rathke's cleft cyst, however, given its slightly atypical location correlation with the patient's clinical history with attention to intracranial logic the radiation and a follow-up exam would be helpful. Please note that this does not explain the patient's symptoms of nystagmus and vertigo.