Female, 10 years old, with bilateral optic disc swelling MRI brain and orbits:The dura of the tentorium is bilaterally thickened and enhancing. To a lesser degree, the dura of the interhemispheric falx is also thickened and enhancing. The remainder of the dura is unremarkable.Morphology of the brain is otherwise unremarkable. No structural abnormalities are seen. The brain parenchyma itself is free of pathologic signal, edema and mass effect. No abnormal parenchymal or leptomeningeal enhancement is seen. No cranial nerve enhancement is detected. There is no intracranial hemorrhage or abnormal extraaxial fluid. The ventricles are normal in size and morphology.Mild flattening of the posterior globes is seen at the optic nerve heads, a finding which can be related to increased intracranial pressure. The orbits are otherwise normal. The optic nerves in particular show no abnormal signal or enhancement. The pituitary infundibulum is thickened and enhancing. The pituitary gland itself is small giving the appearance of a partially empty sella, which may be normal for age but which could also indicate elevated intracranial pressure. The parotid glands are prominent and contain several small cysts or nodules. The partially visualized submandibular glands are also prominent.MRA and MRV brain:The intracranial arterial vasculature is unremarkable. No stenosis or occlusion is seen. No aneurysm or vascular malformation is detected. LIkewise, the dural venous sinuses and deep venous structures are patent.
Dural thickening of the tentorium, and to a lesser degree of the interhemispheric falx, is seen. Also noted is a thickened and enhancing pituitary infundibulum. These findings taken together are very suggestive of neurosarcoid. Other granulomatous processes can be considered, but infection and neoplasia are considered unlikely.Findings are seen in the orbits and sella suggestive of elevated intracranial pressure, which in turn may be secondary to the intracranial process described above. No additional lesions of the orbits are seen. Evaluation of the intracranial arteries and veins is within normal limits. Incidentally noted is prominence of the salivary glands which can be seen in connective tissue diseases and in sarcoid.