Interesting NeuroImaging Case 33 y.o. female
Dec 18, 2015
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
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)
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