Presentation
The patient is clinically diagnosed with morning glory syndrome of the right eye. The parents noticed hyperactivity, prompting a neurologist to rule out associated abnormalities common with this syndrome.
Patient Data
In axial T1W, there is a discontinuity of the right posterior globe with a funnel-shaped morphologic pattern of the optic disc. The right optic nerve appears thickened and elongated. The left posterior globe and left eye appear normal.
In axial T2W, the uveoscleral tract is interrupted, depicted as a loss of integrity of the normal hypointense annulus, additionally, there is effacement of the subarachnoid spaces.
In axial and coronal T1 post contrast, there is enhancement of the distal portion of the right optic nerve.
Dedicated sagittal T1W, sagittal T2W, and coronal images for pituitary assessment reveal that the sella turcica is deformed, with a downward slope of the pituitary gland, optic chiasm, and hypothalamus toward the sellar floor , likely through the persistent craniopharngeal canal. The posterior pituitary appears intact.
Additionally, enlargement of the adenoids is noted.
Unenhanced CT of the skull base bone window demonstrates a corticated tract measuring 4.4 mm in diameter, extending through the sphenoid bone from the sellar floor into the nasopharynx consistent with persistent craniopharyngeal canal, this is associated with a deformed abnormal shape of the sella turcica.
Case Discussion
Morning glory syndrome (MGS) is a rare congenital optic disc anomaly named for its resemblance to the morning glory flower. MGS is typically diagnosed based on clinical examination.
MRI plays a crucial role in supporting and confirming the diagnosis of MGS, particularly in assessing associated cranial anomalies and the extent of optic nerve involvement.
The findings of a persistent craniopharyngeal canal, deformity of the sella turcica, and abnormal displacement of the pituitary gland are notable features associated with morning glory syndrome.
The enlarged adenoids raise the potential risk of infection spreading from the chronically enlarged adenoids to the pituitary region.
Contributed by: Dr. Abeer Saad, MD.
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