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17b - Answer: 48-year-old female presents with headache

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

HISTORY: 

This 48-year-old female presents with headache.

(QUIZ ANSWER) SUPPORTS THE PRIMARY FINDING: 

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:

Slightly low lying cerebellar tonsils. Otherwise unremarkable craniocervical junction. Partial empty sella turcica. 

Normal CP angle cisterns, cochlea, vestibule and 7th and 8th nerve cranial complexes. Mucoperiosteal thickening. Bilateral ethmoid air cells. Unremarkable maxillary antra and mastoid air cells. Prominent optic nerve sheaths. With partial empty sella turcica, low lying cerebellar tonsils and prominent optic nerve sheaths, consideration should be given to diagnosis of benign intracranial hypertension, formally known as pseudotumor cerebri. Does this patient have papilledema? 

Normal appearing white matter. 

Normal extraaxial spaces with no abnormal fluid collections. 

Normal diffusion weighted imaging with no evidence of evolving infarction. 

CONCLUSION: 

In this patient presenting with headaches, combination of partial empty sella turcica, low lying cerebellar tonsils and prominent optic nerve sheaths raises the question of benign intracranial hypertension. Consider evaluation for possible papilledema. Consider MR venography for evaluation of the dural venous sinuses.

LESSON 2, TOPIC 51

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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