Presentation
Headaches and a long history of progressive spastic paraparesis
Patient Data
- Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
An incidental finding on MR of brain and spine was a lesion in the region of the cribriform plate which was of high signal on T2 and FLAIR, and intermediate signal on T1.
Case Discussion
The appearance is typical of a small mucocele. The differential diagnosis includes encephalocele. There appears to be a bony plate between the lesion and adjacent frontal lobe, making encephalocele less likely.
Mucoceles are due to blockage of a sinus ostium and filling of the sinus with mucus, which acts as a slow-growing mass lesion. Posterior ethmoidal mucoceles may cause pressure effects on the optic nerve. Frontal or anterior ethmoidal mucoceles may expand into the orbit to cause proptosis. Infection of a mucocele is a surgical emergency as rapid spread of sepsis may occur.
CT is most useful for diagnosis, as the characteristic sinus expansion and bone thinning is demonstrated. Mucoceles are often of high signal on T1 due to the high protein content.
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