Isolated sagging of frontal lobe

A young female with long standing mild headache.

Axial CT sections show a doubtful overcrowding of structures at supra sellar cistern. Rest of the brain parenchyma show normal attenuation.

Axial T2 images show more convincing obliteration of supra sellar cistern, supra chiasmatic cistern to be specific. Mid brain antero posteriorly elongated and appears to be compressed between temporal lobes.

Sagittal T1 section clearly depicts frontal lobe particularly the anterior commisure portion of corpus callosum sagging down in supra chiasmatic cistern.

Imagingwise to support intra cranial hypotension, there is no marked sagging of brain stem. Pons, Medulla and cerebellar tonsils are at normal level. There is no medialisation of lateral ventricle with compression. No sub dural collection.

Conclusion: isolated sagging of frontal lobe and anterior comissure of corpus callosum in supra chiasmatic cistern. Clinical significance of this finding to patient’s complaint is doubtful. Patient is advised follow up imaging.