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6b - 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: 

Optic nerve sheath dilatation.

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. Partial empty sella.

Scleral flattening. Optic nerve sheath dilatation.

Ventricles are small.

No tonsillar descent.

No enlargement of Meckel's caves.

No internal auditory canal masses.

Maxillary and ethmoid sinus mucosal thickening.

No intraconal masses.

No extra-axial hemorrhage.

No transependymal spread of CSF or sulcal effacement.

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

No suprasellar mass or chiasmal compression.

No intraconal masses.

Cerebral hemispheres and deep nuclei are without hemorrhage, mass or edema.

No optic nerve enhancement.

No masses within the orbital apices.

No subfrontal masses.

Venous sinuses are patent.

No enhancing mass within the internal auditory canals.

No masses within the 5th nerve complexes.

No abnormal meningeal enhancement.

No transependymal spread of CSF or sulcal effacement.

Nigral and pallidal iron stores are maintained. Midbrain and collicular plate volume maintained.

CONCLUSION:

1. Optic nerve sheath dilatation, partial empty sella and scleral flattening may be associated with intracranial hypertension. Finding could be relevant in the described setting of papilledema.

2. No supportive findings of acute venous sinus thrombosis. MRV may be considered to provide further definition if venous thrombosis is of clinical concern.

3. Maxillary and ethmoid sinus mucosal thickening.

4. No intracranial hemorrhage, neoplasm or obstructive hydrocephalus.

5. No supportive findings of acute supra- or infratentorial ischemia or demyelination.

6. No supportive findings of basilar inflammatory process.

7. No intraconal masses. No mass within the orbital apices. No suprasellar mass or chiasma compression.

LESSON 2, TOPIC 18

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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