Radiology and Nuclear Medicine

MR images in a 12 year old with headaches and diplopia shows a heterogeneously enhancing suprasellar mass. There is pituitary infundibulum thickening (blue arrow), and the posterior pituitary bright T1-focus is absent (red). The mass had diffusion restriction, and germinoma was favored. CNS germinomas are centered in the midline, usually in the pineal and suprasellar locations. Suprasellar lesions often present with diabetes insipidus or visual changes. The pineal lesions usually present with headache, precocious puberty, or Parinaud syndrome with upward gaze paralysis. #NeuroWednesday