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. 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

Heterogeneous, partially calcified sellar/suprasellar mass

Pneumocephalus Extending mass

Mass effect on third and lateral ventricles

Differential Diagnosis of Sellar/ Parasellar Masses SATCHMO S uprasellar germinoma A denoma (pituitary) T uberculosis (granulomatous disease) C raniopharyngioma H ypothalamic glioma M eningioma O ddball causes (e.g., epidermoid cyst, Rathke pouch cyst)

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

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