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19b - Answer: 35-year-old male presents with mild to moderate dizziness

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

HISTORY: 

This 35-year-old male presents with mild to moderate dizziness, cloudy vision, headaches and motion sickness for 1.5 weeks with pain on left side of neck.

(QUIZ ANSWER) PRIMARY FINDING: 

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: 

Near complete empty sella.

Dilatation of the optic nerve sheaths and slight flattening of the sclera.

The optic chiasm is not low lying. Cerebellar tonsils are not low lying.

While there are no signs of intracranial mass or neoplasm, the history of headaches, cloudy vision, and the remaining history along with the MR findings are suspicious for idiopathic intracranial hypertension formerly known as pseudotumor cerebri in an atypical demographic of a young man.

Consider funduscopic examination to exclude papilledema or pseudopapilledema.

Does the patient have postural hypotension?

No diffusion restriction is identified.

Following contrast augmentation, no enhancement is identified.

IMPRESSION:

Empty sella and dilated optic nerve sheaths in a patient with cloudy vision and headaches raises the possibility of idiopathic intracranial hypertension or pseudotumor cerebri.

Thank you for your referral in this case.

LESSON 2, TOPIC 57

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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