The spectrum of clinical and neuroradiological evaluation shows that intracranial involvement from plasmacytoma and multiple myeloma must be taken into account in the differential diagnosis of cranial osseous and meningeal disease.

The aim was to assess the value of unenhanced fluid-attenuated inversion recovery T2-weighted sequences (FLAIR-T2) in the differential diagnosis between solitary high-grade gliomas (HGG) and cerebral metastases (CM) appearing as contrast-enhancing cortico-subcortical lesions of the brain. In 69 patients with a contrast-enhancing cortico-subcortical brain lesion (43 HGG, and 26 CM), unenhanced FLAIR-T2 and gadolinium-enhanced FLAIR T1-weighted (Gd-FLAIR-T1) axial images have been reviewed for the involvement of the cortex adjacent to the contrast-enhancing lesion. In 27 (62.79%) out of 43 HGG, and 3 (11.53%) out of 26 CM, the cortex adjacent to the contrast-enhancing lesion showed high signal intensity on unenhanced FLAIR-T2 without enhancement at Gd-FLAIR-T1. Fischer's exact probability test was P = 0.0003 when applied to HGG versus CM categories, indicating a significant difference. The high signal intensity on unenhanced FLAIR-T2 without gadolinium-enhancement of the cortex adjacent to the enhancing lesion is more frequently associated with HGG than CM.

No abstract

Pituitary apoplexy is a potentially life-threatening acute or subacute clinical syndrome occurring from enlargement of the pituitary gland, and pituitary insufficiency, from hemorrhage or ischemia from an unknown pituitary lesion, most frequently being a non-functioning macroadenoma. A close, and multidisciplinary management is required. The purpose of this case report is to increase awareness to pituitary apoplexy presentation and management by reporting clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion. He presented with pituitary apoplexy and brain ischemia at magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. MR angiography (MRA) showed diffuse vasospasm of anterior and posterior circulation. Both MRI and cytochemical examination of the cerebrospinal fluid ruled out subarachnoid hemorrhage. Due to concomitant diseases, and absence of visual deficit, the management was conservative by medical and substitutive therapy, without surgery. Clinical follow-up showed clearcut improvement, and this was consistent with MRI and MRA evidence of vasospasm regression, and clearcut pituitary lesion shrinkage. Pituitary lesions with hemorrhagic infarction presenting with pituitary apoplexy may be associated with vasospasm and brain ischemia at diagnosis, also in the absence of subarachnoid hemorrhage. A correct MR evaluation of patients with PA should include DWI, ADC maps, and MRA. Notably, early diagnosis of PA-associated vasospasm and cerebral ischemia avoids the possibility of their detection only after neurosurgery.