Case Challenge

Head and Neck

Neuro

Sella

Stephen J Pomeranz

Gain confidence interpreting Sella MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Neuroradiology

Case 1 - 76-year-old male presents with hemianopia and mass

Case 2 - 43-year-old female presents history of pituitary microprolactinoma

Case 3 - 21-year-old male presents with visual field defect

Case 4 - 42-year-old male presents with moderate to severe headaches

Case 5 - 53-year-old female presents with Rathke's cleft cyst

Case 6 - 46-year-old female presents with papilledema

Case 7 - 78-year-old female presents with headaches and pituitary lesion

Case 8 - 64-year-old female presents with severe intermittent left-sided headaches

Case 9 - 61-year-old male presents with hypogonadism

Case 10 - 9-year-old female presents with intractable headaches

Case 11 - 63-year-old female presents with right retroorbital pain, paresthesia

Case 12 - 67-year-old female presents with enlarged sella with intermittent anosmia

Case 13 - 13-year-old male presents with blurred vision

Case 14 - 63-year-old male presents with dizziness for four weeks

Case 15 - 46-year-old female presents with papilledema

Case 16 - 40-year-old female presents with history of left lower quadrant visual loss

Case 17 - 48-year-old female presents with headache

Case 18 - 54-year-old male presents with pituitary cyst

Case 19 - 35-year-old male presents with mild to moderate dizziness

Case 20 - 38-year-old male presents with pituitary macroadenoma

Case 21 - 33-year-old male presents with headaches

Case 22 - 56-year-old male presents with possible stroke

Case 23 - 61-year-old female presents with memory loss

Case 24 - 63-year-old male presents with benign neoplasm of pituitary gland

Case 25 - 31-year-old male presents with papilledema

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 25 unique Sella MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Sella MRI Cases

<div>HISTORY:&#160;This 13-year-old male presents with blurred vision.(QUIZ ANSWER) POSSIBLE DIFFERENTIAL:&#160;All of the above.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: No abnormal meningeal enhancement. Venous sinuses are patent.&#160;No intraocular masses. Mild optic nerve sheath dilatation. Partial empty sella. Mild globe flattening. No obstructive hydrocephalus. No abnormal meningeal enhancement. No enhancing internal auditory canal masses. No confluent otomastoid airspace disease.&#160;Cerebral hemispheres and deep nuclei are without hemorrhage, mass or edema. No suprasellar cisternal effacement. Pituitary stalk is intact. No nodularity or enhancement. Cerebral hemispheres and deep nuclei are without hemorrhage or mass. No extraaxial hemorrhage. No obstructive hydrocephalus.&#160;Mild temporal horn prominence with relative preservation of hippocampal volume. No callosal agenesis. No ectopias or migrational disturbance. Hyperintensity within the pineal region could represent pineal cysts. No obstructive hydrocephalus&#160;Venous sinuses are patent. Sagittal sinuses patent. Straight sinus vein of Galen internal cerebral veins are patent. No enhancing parenchymal masses.&#160;Diffusion-weighted images are without a diffusion-restrictive defect. No abnormal optic nerve enhancement. No supportive findings of optic neuritis.&#160;No supportive findings of de- or dysmyelination.&#160;No orbital or retroorbital masses.&#160;No suprasellar masses or chiasmal compression. Orbital apices, optic chiasm, optic tracts, lateral geniculate and visual cortices are unremarkable.&#160;No callosal agenesis. Septum pellucidum is intact.&#160;Small cisterna magna pouch.&#160;CONCLUSION:&#160;1. Partial empty sella, optic nerve sheath dilatation, and globe flattening have been associated indirectly with intracranial hypertension. Eye examination to exclude papilledema is recommended if not already undertaken. Additional differential could include medication effect related to vitamin A, tetracycline-type antibiotics, steroid withdrawal, SLE.&#160;2. No intra- or extraconal masses. No suprasellar masses or chiasmal compression.&#160;3. Mild temporal horn prominence with relative preservation of hippocampal volume.&#160;4. No supportive findings of de- or dysmyelination.&#160;5. No callosal agenesis. No supportive findings of septooptic dysplasia.&#160;6. Venous sinuses appear patent on postcontrast images. MRV may be considered to provide further definition in the setting of possible intracranial hypertension.&#160;7. No intracranial hemorrhage or neoplasm.&#160;8. No Chiari malformation.&#160;9. No supportive findings of septal optic dysplasia and no callosal agenesis.&#160;10. No supportive findings of basilar inflammatory process.</div>

Case

Partial empty sella, optic nerve sheath dilatation, and globe flattening have been associated indirectly with intracranial hypertension. While an eye examination is needed to exclude papilledema, which of the following could also be included as a differential in this case?