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7b - Answer: 78-year-old female presents with headaches and pituitary lesion

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

HISTORY: 

This 78-year-old female presents with headaches and pituitary lesion.

(QUIZ ANSWER) EMPTY SELLA HAS BEEN ASSOCIATED WITH INTRACRANIAL HYPERTENSION: 

True.

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

FINDINGS: 

Intra-ocular lens implants.

Venous sinuses are patent.

No Chiari malformation.

Empty sella.

No abnormal meningeal enhancement.

No enhancing mass within the internal auditory canals.

No enlargement of the extraocular muscles.

No chiasmal compression.

Maxillary and ethmoid sinus mucosal thickening.

No siderosis.

Carotid and basilar artery flow voids are intact.

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

Periventricular white matter hyperintensities may represent gliosis of microangiopathic origin.

No extra-axial hemorrhage.

No transependymal spread of CSF or sulcal effacement.

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

No siderosis on gradient-echo images.

Parietotemporal greater than frontal pattern of cerebral atrophy with relative preservation of hippocampal volume.

Mild optic nerve sheath dilatation.

CONCLUSION:

1. No intracranial hemorrhage, neoplasm or obstructive hydrocephalus.

2. CSF hyperintensity within the sella most likely represent empty sella. Differential could include the Rathke's cyst craniopharyngioma which may be less likely. Endocrine function testing may be considered to provide further definition if clinically relevant.

3. Empty sella and optic nerve sheath dilatation have been associated with intracranial hypertension. Although patient demographic is atypical, eye examination to exclude papilledema is recommended in the setting of headaches.

4. Venous sinuses are patent.

5. No Chiari malformation.

6. No supportive findings of basilar inflammatory process.

7. Periventricular and white matter hyperintensities may represent gliosis of microangiopathic origin. No supportive findings of acute ischemia on diffusion-weighted images. Additional differential appropriate in the appropriate clinical setting could include vasculitis antiphospholipid antibody syndrome.

LESSON 2, TOPIC 21

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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