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11b - Answer: 63-year-old female presents with right retroorbital pain, paresthesia

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 63-year-old female presents with right retroorbital pain, paresthesia.

(QUIZ ANSWER) MOST LIKELY DIAGNOSIS IN THIS CASE: 

Idiopathic intracranial hypertension.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Craniocervical junction demonstrates low lying cerebellar tonsils. No associated hydrocephalus. Pituitary gland, is small. Partial empty sell noted. Brainstem, and corpus callosum unremarkable. Patent dural venous sinuses demonstrated on the postcontrast sequences. 

Orbits and intraorbital contents appear normal. 

Cerebellopontine cistern bilaterally normal as is cochlea, vestibule, and seventh and eighth nerve complexes. Normal appearing Meckel's cave bilaterally. 

Mild global cortical atrophy.

Partial empty sella 

Prominent bilateral optic nerve sheath fluid and low volume intrasellar contents. The former finding can be seen with papilledema. Recommendation to check this patient's eye fields to exclude papilledema. 

CONCLUSION: 

Findings strongly suggest idiopathic intracranial hypertension previously known as pseudotumor cerebri. Consider evaluation for such.

LESSON 2, TOPIC 33

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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