Case 6

I am presented with an MRI study showing sections of the brain and paranasal sinuses. There is herniation of meninges and a gyrus of the right frontal lobe through a defect in the fovea ethmoidalis into the anterior ethmoidal sinus along with its associated sulcus – forming a meningo-encephalocele. There is CSF signal fluid in the right anterior ethmoid cells entering the right nasal cavity, indicating a CSF leak. The right maxillary sinus shows circumferential mucosal thickening and is almost entirely filled with fluid, due to obstruction of the ostium by the meningo-encephalocele causing sinusitis. 

In the first instance, I would obtain contrast enhanced series to assess for meningitis which is associated with this condition.

I would also flag this study for discussion at neurosurgery MDT; the conventional management is reduction and repair of the defect by endoscopic surgery.