13b - Answer: 32-year-old male presents with headaches
HISTORY:
This 32-year-old male presents with headaches.
(QUIZ ANSWER) NOT A PRIMARY FINDING OR DIFFERENTIAL:
Demyelinating disease.
Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.
FINDINGS:
Diffusion-weighted images are without a diffusion-restrictive defect.
Calvarium is intact.
Craniocervical junction is without Chiari malformation.
No callosal agenesis.
Pituitary is small. At the base of the third ventricle just anterior to the mamillary bodies is a 3mm area of T1 hyperintensity. The normal pituitary bright spot within the sella is not definitively identified.
No extraaxial collections or hemorrhage.
Venous sinuses are patent.
Right maxillary sinus mucous retention cyst.
Masticator, parapharyngeal, pharyngeal mucosal, prevertebral and parotid spaces are without masses or adenopathy.
Cerebral hemispheres and deep nuclei are without hemorrhage, mass, edema or gliosis.
7th and 8th nerve complexes are intact. Cochlea and vestibule are intact. Otomastoid airspaces are clear. No internal auditory canal or cerebellopontine angle masses.
No meningeal enhancement or evidence of basilar meningitis.
No parahippocampal atrophy. No supportive findings of mesial temporal sclerosis.
CONCLUSION:
1. Small pituitary and 3mm hyperintensity at the floor of the third ventricle anterior to the mamillary bodies. Finding may represent ectopy of the neurohypophysis. Endocrine evaluation is recommended. Additional differential may include dermoid, lipoma.
2. No evidence of acute supra- or infratentorial ischemia or demyelination.
3. Venous sinuses are patent.
4. No supportive findings of mesial temporal sclerosis. No evidence of parenchymal neoplasm or vascular malformation. No structure or epileptogenic lesion.
5. Right maxillary sinus mucous retention cyst.
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Content reviewed: July 23, 2021