Neuro_MR_Brain: 36 F, postpartum headache, delivery complicated by massive hemorrhage and HELLP.

MRI BRAIN WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 36 years of age, Female, postoperative day two status post emergency total abdominal hysterectomy with massive postpartum hemorrhage, pregnancy complicated by HELLP, now with headache.

 

FINDINGS:

 

Parenchyma: No acute hemorrhage, infarction, mass, or abnormal enhancement. Scattered T2/FLAIR hyperintense foci are seen in the subcortical white matter of bilateral frontal and parietal lobes.

 

Ventricles and extra-axial spaces: Ventricles are normal in size. There is slight diffuse dural enhancement which may be related to 

recent epidural. No brain sag. The pituitary is enlarged and heterogeneous with hypoenhancement and evidence of blood products on GRE and T2-weighted images.

 

Orbits: Normal.

 

Visualized paranasal sinuses: Mild mucosal thickening in the sphenoid sinuses.

 

Mastoid air cells: Small bilateral mastoid effusions.

 

Bones: Mildly patchy bone marrow signal on T1, may be regenerative the setting of pregnancy.

 

Additional comment: None.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: No flow-limiting stenosis or aneurysm.

 

Posterior circulation: No flow-limiting stenosis or aneurysm.

 

Dural venous sinuses: Patent.

 

Additional comment: None.

 

PERFUSION: 

Normal.

  

IMPRESSION:

 

1.  Enlarged heterogeneous, hypoenhancing pituitary gland with evidence of hemorrhage. Recommend correlation with endocrine serology given risk of Sheehan's syndrome and consider follow-up pituitary MRI.

 

2.  Mild scattered subcortical T2/FLAIR hyperintense foci, nonspecific finding.

 

3.  No flow-limiting stenosis or aneurysm. Patent dural venous sinuses.

(Sheehan's syndrome)