Neuro_MR_Brain: 39 F, facial weakness and headache.

MRI BRAIN STROKE PROTOCOL WITHOUT CONTRAST:

CLINICAL HISTORY: 39 years of age, Female, with history of pituitary apoplexy with right-sided weakness.

FINDINGS:

BRAIN: 

Parenchyma: No acute hemorrhage, infarction, or mass.

Sella: There is a predominantly T2 hyperintense nonenhancing sellar and suprasellar lesion measuring approximately 1.6 cm transverse by 1.2 cm AP by 1.5 cm superior to inferior. The mass demonstrates fluid-fluid levels consistent with hemorrhage with associated GRE susceptibility. The mass results in mild superior displacement and mass effect on the optic chiasm and leftward deviation of the infundibulum. Findings are stable from MRI one week prior.

Parasellar structures: Normal cavernous sinuses and carotid artery flow voids.

Ventricles and extra-axial spaces: No ventricular enlargement or extra-axial collection. 

Orbits: Normal. 

Visualized paranasal sinuses: Scattered ethmoid sinus disease. 

Mastoid air cells: Clear. 

Bones: Normal. 

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 bolus perfusion. Nonspecific ASL signal in the region of the torcula, no mass or vascular abnormality seen in this region. 

 

IMPRESSION: 

1.  No evidence of acute infarct. 

2.  Sellar mass with suprasellar extension most consistent with a cystic macroadenoma measuring approximately 1.6 x 1.2 x 1.5 cm with evidence of intralesional hemorrhage, consistent with pituitary apoplexy. There is mild mass effect and superior displacement of the optic chiasm. 

3.  Mildly asymmetric enhancement of the extracranial, mastoid, and labyrinthine segments of the left facial nerve, as well as abnormal enhancement of the cisternal segment of the left facial nerve in the IAC fundus. Findings are compatible with inflammatory changes related to Bell's palsy, or Ramsay Hunt syndrome for which there is clinical concern in this patient.