Presentation
Fall and confusion. Dementia.
Patient Data
No intracranial hemorrhage. No mass effect or herniation.
Incidental hyperdense mass within the expanded sella turcica centered in the left aspect of the sella turcica. Expansile bony remodeling with no discrete bony erosion - consistent with a longstanding process. The adjacent sphenoid sinuses and other paranasal sinuses are well-aerated. Basal cisterns remain capacious.
Periventricular white matter hypoattenuation, likely due to chronic small vessel ischemia. Grey-white matter differentiation is otherwise preserved. Global CSF space prominence, reflecting brain volume loss. Ventricles and CSF cisterns are otherwise normal.
No fracture or surface collection. Paranasal sinuses and mastoid air cells are well aerated.
Impression
No acute intracranial hemorrhage or skull fracture detected.
Incidental hyperdense sellar lesion (20 x 24 x 17 mm), with expansile bony remodeling. Limited characterization given noncontrast study. Differentials include pituitary macroadenoma, diaphragma sellae meningioma, and ICA aneurysm. Comparison with prior imaging if available recommended +/- Further evaluation with MRI suggested.
Case Discussion
The patient had previous imaging at another institution which confirmed a large saccular left cavernous ICA aneurysm which had been slowly enlarging over the last decade. The patient's family had elected not to treat or follow up on the aneurysm due to severe dementia and other comorbidities.
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