Female, 70 years old, history of meningitis and reported positional nasal dripping, abnormality seen in the superior nasal cavity on prior CT, further evaluation with skull base MRI is requested. Small locules of fluid signal are seen along the cribriform plate in the superior right nasal cavity which do appear to communicate with the intracranial subarachnoid space. This finding correlates with the abnormality noted on recent prior CT.Also noted is the presence of several small cystic spaces within the right greater wing of the sphenoid bone, the largest of which is seen along the right sphenoid sinus. Mild prominence of the CSF space anterior to the right temporal lobe is seen which could reflect a small incidental arachnoid cyst.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Numerous scattered foci of white matter T2 hyperintensity are demonstrated in both cerebral hemispheres. No pathologic parenchymal or extra-axial enhancement is observed. No findings are seen to suggest intracranial hemorrhage. The ventricles are normal in size and morphology. Incidental note is made of an expanded and partially empty sella.
1.Findings are seen which very likely represent a small defect in the right cribriform plate, which may be congenital or acquired, allowing communication between the nasal cavity and the intracranial space. The brain parenchyma does not penetrate through this defect, though a small degree of meningeal penetration is a possibility.2.Small cystic spaces within the greater sphenoid wing component of the floor of the right middle cranial fossa are seen likely representing arachnoid granulations. These would be a less likely source for CSF leakage.3.Numerous scattered foci of white matter T2 hyperintensity are seen without significant edema, mass effect or evidence of active inflammation. Findings are nonspecific and may represent the sequelae of chronic microvascular ischemic disease, prior inflammation or infection, vasculitis or demyelination among other possibilities.