Presentation
Headache, vomiting and hormonal imbalances for 6 weeks
Patient Data
Markedly thickened and enhancing pituitary stalk with ill-defined deep white matter hypoattenuation extending to the hypothalamus and crossing the midline. Extensive basal meningeal enhancement. No remodeling or hyperostosis of the sella or paracavernous regions.
Abnormal FLAIR hyperintensity within the infundibulum, optic chiasm and extending into the suprasellar region and hypothalamus. Associated thickening and enhancement of the infundibulum. Confluent FLAIR hyperintensity within the right insular ribbon and posterior right perisylvian fissure. Diffuse patchy basal leptomeningeal enhancement. No beading of vessels on MRA to suggest a vasculitis.
Prominent hilum bilaterally but no eggshell calcification. No pulmonary nodularity, features of fibrosis or cavitation.
Left femoral head destruction, sclerosis with subchondral cysts and joint space loss in keeping with avascular necrosis of the left hip.
Follow-up imaging after 2 years of high-dose steroids showing complete resolution of basal meningeal and leptomeningeal thickening and enhancement. The thickening and abnormal enhancement of the pituitary stalk have resolved. Incidental paranasal sinus opacification
Case Discussion
The patient had an endobronchial biopsy with histopathology demonstrating non-caseating granuloma which confirmed the pathological diagnosis of sarcoidosis. Subsequently received high-dose steroids treatment with improvement. The patient developed avascular necrosis of the left hip secondary to the high-dose steroids.
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