77 years Male (DOB:5/1/1939)Reason: mass seen in pituitary, headache and dizziness History: headachePROVIDER/ATTENDING NAME: JAMES J WALTER MRI pituitary:The pituitary is enlarged measuring 20 x 18 mm sagittal dimensions and extends into the suprasellar cistern where it displaces the optic chiasm superiorly. The cavernous sinuses are intact bilaterally.MRI of the brainThere are multiple punctate foci of diffusion restriction present in the frontal lobes bilaterally as well as the occipital lobes, right thalamus, and cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate opacification of the left maxillary sinus associated with coastal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is hypoplastic. The posterior communicating arteries are very small. The left vertebral artery is larger than the right vertebral artery.
1.Findings are available multiple diffusely distributed microinfarcts in both hemispheres and the posterior fossa. This consistent with an embolic shower2.There is a compatible with a pituitary macroadenoma which displaces the optic chiasm.3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 