PMC4597298_01
Pre- and post-contrast magnetic resonance images show the pituitary to be diffusely enlarged with homogenous enhancement, measuring 1.3 cm x 2.0 cm x 1.1 cm in cranial-caudal, transverse, and anterior-posterior dimensions, respectively. The pituitary stalk is markedly thickened and intensely enhancing
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F1
A subsequent magnetic resonance imaging (MRI) obtained at that time showed a diffusely enhancing and enlarged pituitary gland [Figure 1].
Magnetic resonance images obtained 1-month after surgery made with and without contrast show a decrease in size of the pituitary gland with no suprasellar extension or abnormal enhancement pattern
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F2
The patient's condition improved, and a subsequent MRI scan showed a decrease in size of pituitary back to a more normal configuration [Figure 2].
Axial T2 flair magnetic resonance images demonstrating hyperintensity in the bilateral mesial temporal lobes left greater than right, as well as contrast enhancement, in right mesial temporal lobe on sagittal section
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F3
MRI showed T2 signal changes, as well as bilateral contrast enhancement, in the medial temporal lobes [Figure 3].
Axial magnetic resonance T2 flair image on the left and postcontrast T1 image on the right showing interval improvement in enhancement pattern with stable hyperintensity of bilateral mesial temporal lobes
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F4
T2 hyperintensities in bilateral temporal lobes with improvement in the enhancement pattern of the left temporal lobe [Figure 4]. The patient was discharged on IV acyclovir and a steroid taper.
Preoperative magnetic resonance images 2 months after discharge. T2 signal changes and contrast enhancement pattern has increased, since the last magnetic resonance imaging scan
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F5
T2 signal abnormality and enhancement of the bilateral temporal lobes with increased mass effect [Figure 5]. The pituitary gland remained stable.
Axial magnetic resonance T2 (top) and T1 postcontrast (bottom) images taken 3 months after discharge after treatment with cyclophosphamide and prednisone showing improvement in both signal abnormality and contrast enhancement
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F6
T2 signal abnormality and contrast enhancement pattern [Figure 6]. There has been no improvement clinically.