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Interesting NeuroImaging Case

Interesting NeuroImaging Case. 33 y.o. female. Clinical History. A 33 y.o. female with a PMH of asthma, gallstones, diabetes with no documented history of diabetic retinopathy.

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Interesting NeuroImaging Case

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  1. Interesting NeuroImaging Case 33 y.o. female

  2. Clinical History • A 33 y.o. female with a PMH of asthma, gallstones, diabetes with no documented history of diabetic retinopathy. • She presents to an OSH with a several month history of “blurred vision” and headache. Also complains of seeing “blue lines and purple.” • Physical examination reveals a left optic neuropathy (3/200 OS) and a right homonymous hemianopsia

  3. Heterogeneous, partially calcified sellar/suprasellar mass

  4. Pneumocephalus Extending mass

  5. Mass effect on third and lateral ventricles

  6. Differential Diagnosis of Sellar/ Parasellar Masses SATCHMO • Suprasellar germinoma • Adenoma (pituitary) • Tuberculosis (granulomatous disease) • Craniopharyngioma • Hypothalamic glioma • Meningioma • Oddball causes (e.g., epidermoid cyst, Rathke pouch cyst)

  7. Diagnosis Craniopharyngioma • Derived from Rathke’s pouch • Often large, cystic, locally invasive • Characteristic calcified appearance on skull x-ray and CT images • Patients often young (50% < 20 y.o.) usually showing visual defects and signs of increased ICP • Treatment: surgical resection +/- post-op radiation

  8. References Adams, Victor, and Ropper. Principles of Neurology. 6th ed. McGraw-Hill, 1997, pp.672-73. Kasper et al. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill, 2005, p.2081. Gay and Woodcock. Radiology Recall. Lippincott Williams and Wilkins, Baltimore, 2000.

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