Dr. Chitrangada Jitendra
Radiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been struggling for approximately two years with symptoms such as pulsatile tinnitus, dizziness, vertigo, orthostatic headaches and general fatigue. I had an MRI that showed empty Sella with some herniation of CSF into the pituitary gland area. I have a set of images from a CT angiogram as at the time I was under investigation for some sort of arteriovenous malformation (suspected) but was given the all-clear. The reason for the second opinion is I believe the cause of my symptoms has been missed as the coronal and sagittal images from my recent scan I do not think have been looked at. In my opinion, there seems to be a defect in the left cribriform plate adjacent to an opacified ethmoid air cell. I think this may be causing a CSF flow problem and hence all my symptoms. I have attached a snapshot of the area but please could you look at the coronal and sagittal images?
Hello,
Welcome to icliniq.com.
The MRI findings are suggestive of benign intracranial hypertension and these also correlate well with your symptoms. In the scan provided, no obvious defect is seen in either of the cribriform plates. The CT angiogram is within normal limits.
But still, if you have rhinorrhea (a runny nose) then the possibility of CSF leak needs to be ruled out accurately using CT cisternography scan.
Please upload the coronal images so that I can evaluate the complete scan.
Patient's Query
Hi doctor,
Thanks for the response.
The coronal and sagittal MIP images should be uploaded onto the system. You can view them in the Ambra viewer with the link I am providing. Let me know if I need to re-upload them - series 9 and 10 on the above link, but you have to scroll through.
Hello,
Welcome back to icliniq.com.
I rechecked the scans and even in the coronal and sagittal sections (attachments removed to protect the patient's identity), I do not see a breach in the bony lamina papyracea or the cribriform plate. The sinus walls appear intact to me.
Also, a feature of note is the arachnoid outpouchings which appear in benign intracranial hypertension. That gives the same appearance as seen in your scan along the left ethmoid cells. Still, I feel that to be definitively sure, a CT cisternography would be the best modality to check for the leak.
Regards.
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Radiology
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