Presentation
Patient presenting with long intermittent history of headaches, now with focal left temporal seizures.
Patient Data
No acute finding; no mass, bleed or infarct.
Features compatible with idiopathic intracranial hypertension, with distended pituitary fossa/sellar arachnoid herniation, tortuous optic nerves and small pitting lucencies in the left middle cranial fossa skull base.
Right sphenoid bone sclerosis and expansion compatible with fibrous dysplasia.
Meningoencephaloceles from the left temporal lobe into some of the left sphenoid skull base defects, with some T2w hyperintensity.
Normal major vascular flow voids, no dedicated venogram performed. No diffusion abnormality. Normal pituitary gland/stalk signal in distended pituitary fossa. Cosmetic facial filler.
Fused bone windows and FLAIR
Fused images demonstrating the herniated / entrapped left temporal pole cortical tissue (orange) in the middle cranial fossa defects.
Case Discussion
Meningoencephaloceles are an important review point for both patients presenting with seizures and those with a background typical for IIH.
The patient also described a wet sensation in her contralateral ear, but no convincing CSF has been identified. This can follow a change in headache pattern from high pressure (leading to bone remodeling / thinning) to a CSF leak resulting in low pressure symptoms (craniospinal hypotension).
They can be difficult to identify on MRI so when suspected performing a CT with dedicated bone reconstruction algorithm can be useful.
The right sphenoid fibrous dysplasia is an incidental finding.
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