0:00

So this was a,

0:01

a patient that had an encephalocele involving the right anterior skull base.

0:06

And what we see here, uh, especially seen on the T twos,

0:10

is that we see a defect here involving the anterior cranial fossa and there's

0:15

herniation of, uh, intracranial elements,

0:18

which includes dysplastic brain and also C S F extending into the right nasal

0:23

cavity.

0:25

So this was an example of a frontal nasal or frontal eth mortal ence foal.

0:30

I think, I think either one of these terms are fine. Um,

0:33

if you think it's extending into the ethmoid,

0:35

then it's a frontal eth mortal ence foal.

0:37

If it's extending into the nasal cavity, it's frontal nasal ence,

0:41

probably frontal, um, ethmoidal phae, uh,

0:44

encephalocele is probably the most accurate on this because it looks like it's

0:48

just lateral to the olfactory sulcus. Uh,

0:52

the majority of it is lateral and it's involving the right, um,

0:55

ethmoid air cells. Any questions on this one?

1:00

For this kind of ence, would that cost, uh,

1:03

in intracranial hypotension?

1:07

Uh, that's a really good question. Um, it's possible, yes. Yeah.

1:11

The reason why I hesitate Han is that, um, yes, if, if this is,

1:17

uh, constant leakage of C S F, then yes,

1:20

it could result in intracranial hypotension.

1:23

But the reason why I hesitated is that you can have ence foals involving other

1:27

parts of the brain that are actually due to intracranial hypertension.

1:33

So for instance, you can have meles cave encephalocele,

1:38

you can have ence foals involving the teman

1:42

and the teman mast sodium that are due to intracranial hypertension.

1:46

So in this particular case, if you do see this, then yes,

1:50

it can result in intracranial H Y P O hypotension,

1:55

but just realize some encephalocele can actually be due to intercranial

1:59

hypertension because, um, it's essentially a,

2:03

a release valve if the intercranial pressure goes up too high.

2:08

Okay. They answered my question. Challenging. Yeah. Okay.

2:12

Have to see a lot other signs for hyper or hyper.

2:16

Well, say that again so I understand what you're saying.

2:19

Oh, so me,

2:19

meaning we have to see for other imaging features of hyper

2:24

or hypo, like yes, any sinus stenosis or validation,

2:29

and also maybe need to correlate with lumper puncture, opening pressure.

2:35

Right. And also the pituitary gland. I have to admit,

2:38

like the first thing that I look at when I'm looking at intracranial

2:41

hypertension p e r, is I look at the pituitary gland.

2:45

If the pituitary gland is flattened,

2:47

then I start thinking of idiopathic intracranial hypertension.

2:50

My biggest challenge is that I see,

2:52

I see so many I a c studies, um,

2:57

I see a large variability of variability enlargement of the transverse and the

3:01

sigmoid sinuses. So, um,

3:04

sometimes I don't think that's a super reliable sign. When hypo,

3:08

when idiopathic intracranial hypotension was first,

3:13

um, described,

3:15

you had to have about four or five findings associated with hypotension,

3:20

um, and hypertension. H Y P E R, like I said,

3:24

I kind of look primarily at the flattening of the pituitary gland and dilatation

3:29

and redundancy of the optic nerve sheets.

3:31

Then I'll start looking for dilatation of meles caves and then maybe, yeah,

3:36

narrowing the transverse sinus. Although I have to admit,

3:39

I don't think that's as,

3:40

as a reliable as sign as some of the other signs that I, that I, that I use.

3:45

Okay. So the pituitary green is the first point We look

3:50

Pituitary. Yeah. That's,

3:51

I always start looking off of those midline structures because of the pituitary

3:56

is enlarged in a older patient, if it's really sort of enlarged and,

4:01

and they're sagging of the tonsils,

4:03

and I start thinking about intracranial hypotension.

4:06

But if a pituitary's flattened, especially in an overweight patient,

4:10

and then I start seeing the dilatation of the optic nerve sheet,

4:14

then I start thinking about hypertension.