Unspecified papilledema [H47.10], Reason for Study: ^Reason: disc swelling History: photosensitivity Brain MRIOn axial scan, bilateral orbital globe show subtle flattening of posterior globe, subtle buckling (tortuosity) of optic nerves (left more prominent than right) and slightly prominent CSF spaces of distal optic nerve sheath. The pituitary gland shows slightly flattened superior aspect of the gland considering the patient's age but there is no evidence of empty sellar. Constellations of these findings indicate possible diagnosis of intracranial hypertension. There is a well circumscribed extra axial lesion at the midline hypothalamus, tuber cinereum area. The lesion is measured about 4.2mm (RL) x 5.6mm (AP) x 2.9mm (CC). The lesion shows high signal intensity on T1, low signal intensity on T2, low signal intensity on Fat saturation T1 and without evidence of enhancement, thus indicating fat containing lesion. On gradient echo images, there are subtle signal loss especially on peripheral and anterior aspect of the lesion indicating possible mineralization. To confirm, head CT with thin section around the hypothalamus can be considered if clinically indicated. Differential diagnosis include hypothalamic lipoma/ osteolipoma or Rathke's clef cyst. Possibility of dermoid or epidermoid cannot be completely excluded but slim. Scattered FALIR/T2 high signal intensity lesions at bilateral frontal lobes and right insular cortex are seen which are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.
1. Subtle flattening of posterior globe, slightly prominent CSF spaces around distal optic nerve sheath and subtle buckling of optic nerves especially left side indicate possible intracranial hypertension. 2. Hypothalamic fat containing lesion. Differential diagnosis include lipoma/osteolipoma and Rathke's cleft cyst.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain MRV.