Herniation of the optic chiasm and third ventricle into a partial empty sella

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Known history of pituitary prolactinoma a few years ago. Treated conservatively with dopamine agonists. Lost clinical follow-up, presenting now with visual impairment.

Patient Data

Age: 55 years
Gender: Male
This study is a stack
Sagittal
T1
This study is a stack
Sagittal
T2
This study is a stack
Coronal
T1
This study is a stack
Coronal
T2
This study is a stack
Coronal
T1 C+
This study is a stack
Sagittal
T1 C+
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
Dynamic C+
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
Sagittal
T2
Download
Info

There is a prominent enlarged sella, which is partially empty, and has an associated downward herniation of the floor of the third ventricle, optic chiasm and proximal segments of the anterior cerebral arteries within. The pituitary gland shows to be relatively enlarged and displaced peripherally against the sellar walls.

The remainder of the brain is unremarkable.

Case Discussion

Herniations into the sella have been described associated either with primary or secondary empty sella. Such as in this case, visual disturbances have been well documented associated with secondary empty sella (medical/surgical therapy of a sellar tumor like marcoadenoma). 

Unfortunately, previous imaging were not available to make a clear correlation with the tumor (documented macroadenoma).

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.