Presentation
Two-day history of headache, hypertension, dizziness, and gait instability.
Patient Data
Axial non-contrast CT of the head shows a round mass-like lesion in the suprasellar cistern. No acute intracranial hemorrhage is seen.
Sagittal non-contrast CT of the head shows a lesion extending above the level of the diaphragma sellae into the suprasellar cistern. It demonstrates mildly heterogenous attenuation.
Axial FLAIR MRI of the brain demonstrates an intrasellar mass with heterogeneous hyperintense signal.
Coronal T1 MRI of the brain shows an intrasellar and parasellar mass that extends superiorly to touch the optic chiasm. It extends into the right cavernous sinus.
Sagittal T1 MRI of the brain shows a lesion extending above the level of the diaphragma sellae into the suprasellar cistern. It demonstrates mildly heterogenous signal.
Case Discussion
This case demonstrates a pituitary macroadenoma with non-hemorrhagic apoplexy. MRI remains the gold standard modality in imaging when compared to non-contrast CT and further supports "apoplexy" as a clinical diagnosis.
This case was co-authored by:
Kabir Grewal, MS4
Florida State University