Reason: 14 y/o with autism macrocephaly optic nerve hypoplasia primary generalized epilepsy. CT head normal 2003 o other neuroimaging done. Please evaluate for other developmental anomalies History: 14 y/o with autism macrocephaly optic nerve hypoplasia primary generalized epilepsy. CT head normal 2003 no other neuroimaging done. Please evaluate for other developmental anomalies. There is a nonenhancing lesion in the suprasellar cistern measuring 1.8 x 1.7 cm in axial dimension and 1.6 cm in craniocaudal dimension which follows CSF on all sequences, likely representing an arachnoid cyst. The anterior pituitary gland is small and may be slightly compressed downward within the sella. Pituitary infundibulum is diminutive and incompletely visualized in its course. There is evidence of posterior pituitary ectopia appearing as an enhancing lesion with intrinsic T1 shortening, best seen on T1 axial orbit images, located in the midline at the median eminence of the hypothalamus. The optic chiasm is displaced superiorly and appears diminutive. The bilateral optic nerves also appear small. There are 3 punctate subcortical T2 hyperintensities, the largest in the right parietal subcortical white matter without associated diffusion restriction. No evidence of acute infarct. Septum pellucidum is present. No hydrocephalus. Remainder of the midline structures are intact including a normal-appearing corpus callosum. There is no midline shift or herniation. The globes are normal in appearance. The paranasal sinuses are unremarkable.
1.Evidence of posterior pituitary ectopia which is located at the median eminence of the hypothalamus. Pituitary stalk is severely diminutive and poorly visualized. Anterior pituitary is small. There is also hypoplasia involving the bilateral optic nerves and chiasm. Septum pellucidum is present. Constellation of findings are within the spectrum of septic optic dysplasia. 2.Likely an arachnoid cyst involving the suprasellar cistern measuring approximately 1.8 x 1.7 x 1.6 cm with mild mass effect on the optic chiasm superiorly and the anterior pituitary inferiorly.3.A few punctate scattered subcortical T2/flair hyperintensities which are are nonspecific and may be related to prior inflammation/infection, ischemia, or less likely demyelination.