Wk 7, Case 3 - Review

Patient History
CSF leak. Nasal drip.

Findings
Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Pituitary gland is not enlarged. Diffusion imaging demonstrates no evidence of recent large infarct. Axial FLAIR and T2-weighted images demonstrate prominent sulci and ventricles. No evidence of vasogenic edema or mass effect.

Coronal T1 and T2 weighted images demonstrates an abnormality involving the anterior skull base. There is a defect of the bony contour of the anterior skull base in the expected location of the fovea ethmoidalis, lateral lamella and cribriform plate. There is a inferior herniation of the right frontal pole and gyrus rectus through a potential bony defect extending into the right ethmoid air cell. This is surrounded by adjacent CSF and represents a possible encephalocele. This finding should be correlated with beta 2 transferrin testing of any nasal fluid. Coronal CT of the paranasal sinuses would help evaluate the integrity of the anterior skull base.

Axial images demonstrates peripheral mucosal thickening involving a slightly hypoplastic right maxillary sinus.

Conclusions
1. Findings suggestive of a bony defect involving the right anterior skull base with herniation of dysplastic brain contents and CSF indicative of a right frontoethmoidal encephalocele. Coronal CT of the paranasal sinuses and anterior skull base would help evaluate bony anatomy of the anterior skull base. Correlation with beta 2 transferrin levels of nasal fluid would be helpful.
2. No evidence of vasogenic edema or mass effect.