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15b - Answer: 46-year-old female presents with papilledema

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

HISTORY: 

This 46-year-old female presents with papilledema.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

All of the above.

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

FINDINGS:

No extraaxial collections or hemorrhage. 

Venous sinuses are patent. 

Sphenoid sinus mucous retention cyst. Ethmoid sinus mucosal thickening. 

Deviated nasal septum to the left. 

Carotid and basilar artery flow voids are intact. 

Seventh and eighth nerve complexes are intact. Cochlea and vestibule are intact. Otomastoid airspaces are clear. No internal auditory canal or cerebellopontine angle masses. 

Masticator, parapharyngeal, pharyngeal mucosal, prevertebral and parotid spaces are without masses or adenopathy. 

Diffusion-weighted images are without diffusion-restrictive defect. 

Empty sella, optic nerve sheath dilatation, globe flattening, suprasellar cisternal effacement. Ventricles are small. 

Calvarium is intact. 

Craniocervical junction is without Chiari malformation. 

Hyperintensity right subinsular may represent gliosis of microangiopathic origin. 

Prominent pharyngeal soft tissues with narrow oropharyngeal inlet.

CONCLUSION: 

1. Scleral flattening, optic nerve sheath dilatation, suprasellar cisternal effacement, small ventricles have been associated indirectly with pseudotumor cerebri. Findings may be relevant to provided history of papilledema. 

2. Right subinsular parenchymal hyperintensity with differential including migraine, gliosis of microangiopathic origin, postinflammatory. 

3. Sphenoid sinus mucous retention cyst, ethmoid sinus mucosal thickening. 

4. Prominent pharyngeal soft tissues with narrowing oropharyngeal inlet, consider sleep apnea.

LESSON 2, TOPIC 45

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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