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Thirty year old African American.

Pituitary adenoma

Craniopharyngioma

Meningioma

Metastasis

Aneurysm

Rathke cleft cyst

Granuloma (TB, sarcoid, EG)

Abscess.

Multi-system noncaseating granulomatous disorder of unknown etiology

Favors temperate climates

Rural areas more common (esp. southeastern US)

In US more common in blacks

Female predominance

In US 10-17x more common in black women compared to white women.

Occurs in 5-10% usually as part of the systemic manifestation

Protean

Extremely steroid sensitive.

Radiology (2 Patterns):

Chronic basilar leptomeningitis with involvement of the hypothalamus, pituitary stalk, optic chiasm, and unilateral or bilateral cranial nerve involvement (II and VII)

Parenchymal nodules +/- calcification.

MRI:

White matter and periventricular high signal on long TR / long TE sequences (MS mimic)

Hydrocephalus

Atrophy

Periventricular enhancement

Extra-axial masses (meningioma mimic)

Chiasmal enhancement / swelling

Enhancing nerve roots

Enhancing spinal cord parenchymal masses.