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8b - Answer: 64-year-old female presents with severe intermittent left-sided headaches

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

HISTORY: 

This 64-year-old female presents with severe intermittent left-sided headaches crescendo in nature with vertigo for six months, and recent memory loss.

(QUIZ ANSWER) SIGNS OF PSEUDOTUMOR CEREBRI SEEN IN THIS CASE: 

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:

Empty sella. 

Mild cerebellar tonsillar sagging. 

Cerebral atrophy for age with hydrocephalus ex vacuo suggests primary neurodegenerative atrophy. 

Dilatation of the optic sheath subarachnoid space is present. 

On the MR cisternogram crossing vessels are noted in close proximity to the right trigeminal nerve. Are the patient's symptoms right-sided regarding facial pain? No intracranial enhancement is identified. 

CONCLUSION: 

1. Three signs of pseudotumor are noted namely empty sella, optic sheath dilatation, and tonsillar sagging; however, a pattern of neurodegenerative cerebral cortical atrophy is also noted raising the possibility of superimposed neurodegenerative change. 

2. Crossing vessels in close proximity to the right trigeminal nerve. This is described as one sign that can produce trigeminal neuralgia.

LESSON 2, TOPIC 24

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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