Presentation
Gradual development of ptosis and diplopia.
Patient Data
There is right parasellar ill-defined soft tissue mass, which is isointense to brain grey mater on T1, T2 and FLAIR sequences; and intensely contrast enhancing. Involvement of right cavernous sinus and encasement of ipsilateral internal carotid artery are also evident. Findings are compatible with parasellar meningioma. For neurosurgical assessment and evaluation.
There are multiple bihemispheric periventricular white mater ischemic changes.
No acute infarction or hemorrhage.
Normal brain stem and cerebellum.
Normal ventricular system.
No shift in the midline structures.
Case Discussion
This is a presumptive radiological diagnosis, with pending neurosurgical decision for Gamma knife surgery.
The third cranial nerve is more susceptible to compression against the interclinoid ligaments above and the petroclinoid ligament below than the other cranial nerves in the cavernous sinus. For this reason, isolated third cranial nerve palsy may result from lateral extension of pituitary adenoma or other primary intrasellar/parasellar masses like our case here.
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