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25b - Answer: 31-year-old male presents with papilledema

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

HISTORY: 

This 31-year-old male presents with papilledema. Hit head on a car door. No current symptoms.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Chiari malformation.

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

FINDINGS:

Calvarium is intact. No Chiari malformation. Empty sella. Small cyst in the pineal region. 

Atlantodental interval is normal. 

Deviated nasal septum to the right. Narrowing of the left ostiomeatal unit. 

No enlargement of the extraocular muscles. 

Carotid and basilar artery flow voids are intact. No internal auditory canal masses. Sphenoid, ethmoid, maxillary sinus mucosal thickening. Frontal sinus mucosal thickening. 

No masses within Meckel's caves or cavernous sinuses. 

No confluent otomastoid airspace disease. 

Left jugular bulb is dominant. No supportive findings of jugular bulb or venous sinus thrombosis. 

Optic nerve sheath dilatation, globe flattening. Ventricles are small. 

Cerebral hemispheres and deep nuclei are without hemorrhage, mass, or edema. No transependymal spread of CSF or sulcal effacement. Nigral and pallidal iron stores are maintained. 

No masses in the masticator, parapharyngeal, or pharyngeal mucosal spaces. 

No mass within the 3rd nerve complex or interpeduncular fossa. 

No mass in the 5th nerve complexes. 

No masses within the jugular foramina. 

No siderosis. 

Diffusion-weighted images are without a diffusion-restrictive defect. 

CONCLUSION: 

1. Empty sella, optic nerve sheath dilatation, globe flattening, small ventricles have been associated with intracranial hypertension. Finding may be relevant in the described setting of papilledema. 

2. Left jugular bulb is dominant. No supportive findings of venous sinus thrombosis on noncontrast images. MRV may be considered to provide further definition if clinically relevant. 

3. No intracranial hemorrhage or obstructive hydrocephalus. No evidence of intracranial neoplasm on noncontrast images. 

4. Maxillary, ethmoid, sphenoid, frontal sinus mucosal thickening. 

5. No Chiari malformation.

LESSON 2, TOPIC 75

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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