Neuro_MR_Sella: 57 F, positional hypotension.

HISTORY: Vertigo and headaches for one month.

FINDINGS: There is a slight enlargement and upward bulging of the pituitary, without evidence of focal mass or hypoenhancing lesion. There is no evidence of optic chiasmal mass effect or compression. The pituitary infundibulum is in a midline location. There is mild asymmetric 

enlargement of the right lateral ventricle frontal horn. There is diffuse pachymeningeal enhancement. On precontrast T1-weighted sequences, there is diffuse thickening of the dura, and there is also diffuse hyperintensity on FLAIR sequences and thickening of the dura or less likely underlying fluid collection, with thickening up to approximately 2 mm maximally. The basal cisterns are mildly narrowed. There is no evidence of herniation.

IMPRESSION:    

Findings that are most suggestive of meningitis given diffuse pachymeningeal enhancement and thickening extending to the basal meningeal surfaces. Neoplastic meningeal infiltration is also not excluded. A third possibility would be spontaneous intracranial hypotension, given slight pituitary swelling, although there is no 

significant brainstem sagging or brain swelling.

There is mild pituitary convexity but no focal mass identified, which may be related to pituitary hypertrophy.

(Intracranial hypotension)