1b (Brain) - Answer: 53-year-old female with history of headaches and dizziness

HISTORY: 

This 53-year-old female presents with a history of headaches and dizziness.


(QUIZ ANSWER) PRIMARY FINDING: 

Sellar and suprasellar mass.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Calvarium is intact. 

Craniocervical junction is without Chiari malformation. 

Large T1 hypointense, T2 hyperintense 2.5 x 1.3 x 1.7cm sellar and suprasellar mass with possible blood-fluid level which compresses the optic chiasm and effaces the right hypothalamus extending to the base of the 3rd ventricle. No cavernous sinus extension. The sella is enlarged. 

No extraaxial collections or hemorrhage. 

Confluent periventricular and subcortical hyperintensities are likely to represent gliosis of microangiographic origin. Hyperintensity within the left pons is likely to represent an area of lacunar infarction. 

Pontine hyperintensities may also represent gliosis of microangiographic origin. 

7th and 8th nerve complexes are intact. Cochlea and vestibule are intact. Otomastoid air spaces are clear. No internal auditory canal or cerebellopontine angle masses. 

No obstructive hydrocephalus. 


CONCLUSION

1. 2.5 x 1.3 x 1.7cm sellar and suprasellar mass with chiasmal compression and right hypothalamic effacement. Apparent blood-fluid level and signal characteristics consistent with pituitary apoplexy. Underlying lesion may be a macroadenoma, craniopharyngioma or conceivably Rathke's cyst. The presence of hemosiderin staining suggests that the hemorrhage may be subacute to chronic possibly of 4 to 14 day range. Urgent neurosurgery consultation is recommended. 

2. Supra- and infratentorial parenchymal hyperintensities likely to represent gliosis of microangiographic origin related to chronic hypertension and/or metabolic disease. Area of remote lacunar infarction within the left pons as well as pontine gliosis. 

3. No obstructive hydrocephalus. 

4. No evidence of kissing carotids. Sphenoid sinuses aerated and sella is enlarged.