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Tuberculous Meningitis
Joseph Junewick, MD FACR
over 7 years ago
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Case History


17 year old female with polyendocrinopathy.


Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR
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Case Images


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Reveal Findings

MR – Sagittal T2 and sagittal and coronal post-gadolinium T1 images of the sella tursica demonstrate bulbous enlargement and enhancement of the pituitary stalk.

Reveal Discussion

The normal pituitary stalk is widest superiorly and tapers inferiorly, measuring 3.5 mm near the median eminence, 2.88 mm at its midpoint, and 1.9 mm at its insertion into the pituitary gland. The pituitary stalk is isointense relative to the optic chiasm on T1 and T2 weighted images and intensely enhances with intravenous gadolinium (absent blood-brain barrier). Deviation or tilt of the pituitary stalk can be normal. Enlargement of the pituitary stalk greater than 2–3 mm on MRI is abnormal. Pathologic thickening is fairly evenly divided among tumor and tumor-like lesions (e.g., Langerhans cell histiocytosis, germ cell tumor, glioma and metastasis), infectious and inflammatory conditions (e.g., lymphocytic infundibuloneurohypophysitis, Wegener’s granulomatosis, sarcoidosis, tuberculosis) and congenital etiologies (e.g., duplication, pituitary hypoplasia, ectopic posterior pituitary).

Reveal Diagnosis

Thickened Pituitary Stalk

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