This document contains 16 figures showing magnetic resonance images of various hypothalamic lesions. The images depict lesions including gliomas, germinomas, primary CNS lymphomas, hamartomas, Langerhans cell histiocytosis, metastases, hemangioblastomas, choristomas, craniopharyngiomas, dermoid cysts, Rathke's cleft cysts, colloid cysts, encephalitis, sarcoidosis, ectopic posterior pituitary glands, and Wernicke's encephalopathy. Each image is labeled and captioned, identifying key features of the lesions.

1. 10Hypothalamic Lesions on
Magnetic Resonance Imaging

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig SK 10-1 Glioma. (A) Sagittal T1-weighted image in a
2-year-old emaciated and hyperactive girl shows a
large midline mass involving the optic chiasm (straight
arrow) and hypothalamus (curved arrow). (B) Coronal
contrast-enhanced T1-weighted image shows
nonuniform enhancement of the tumor, which extends
superiorly to the foramen of Monro and causes
obstructive hydrocephalus.21

4. • Fig SK 10-2 Germinoma. Sagittal T1-weighted
scans before (A) and after (B) administration of
contrast material in an 18-year-old man with
diabetes insipidus show enhancing masses in the
floor of the anterior third ventricle (straight black
arrow) and pineal region (curved arrow). The
optic chiasm (white arrow) is not involved.21

5. • Fig SK 10-3 Primary CNS lymphoma. (A)
Sagittal and (B) axial T1-weighted images after
injection of contrast material show enhancing
mass lesions in the hypothalamus (arrow) and
left thalamus (arrowhead).21

6. • Fig SK 10-4 Hamartoma. Coronal (A) T1-weighted
and (B) T2-weighted scans in a 5-year-old girl
with precocious puberty show a midline
hypothalamic mass (arrows) bulging into the
inferior floor of the third ventricle. The lesion is
isointense on both images and is centered in the
region of the tuber cinereum.21

7. • Fig SK 10-5 Langerhans cell histiocytosis. (A)
Initial sagittal T1-weighted image after injection
of contrast material in a 9-year-old boy with
diabetes insipidus shows a large enhancing
hypothalamus mass splaying the cerebral
peduncles. (B) Corresponding image 3 weeks
after low-dose radiation treatment shows a
significant decrease in size of the lesion.21

8. • Fig SK 10-6 Metastasis. Sagittal T1-weighted contrast
image demonstrates a large clival mass with
destruction of the sella and invasion of the suprasellar
region. Note the small enhancing hypothalamic mass
(arrow) representing metastasis from breast cancer.22

9. • Fig SK 10-7 Hemangioblastoma. Coronal T1-
weighted contrast image indicates that the
complex mass contains cystic components with
marginal enhancement (short arrow) and an
intensely enhancing mural nodule (long arrow).22

10. • Fig SK 10-8 Choristoma. Sagittal T1-weighted
contrast image shows a well-defined suprasellar
mass (arrow). Initially isointense relative to brain,
the mass shows inhomogeneous enhancement.22

11. • Fig SK 10-9 Craniopharyngioma. Coronal T1-weighted contrast
image shows a lobulated suprasella tumor with intrasellar
extension. The tumor is formed predominantly of multiple cysts
with varying signal intensities that show thin mural enhancement
(arrows). Note the associated asymmetric dilatation of the lateral
ventricle.22 (Courtesy of Yasser Regab, M.D., Cairo, Egypt.)

12. • Fig SK 10-10 Dermoid cyst. (A) Sagittal T1-weighted
image shows a well-defined hyperintense lesion
(arrow) at the floor of the hypothalamus, posterior to
the infundibular stalk. (B) On a coronal fat-suppressed
T1-weighted image, the lesion (arrowheads) exhibits
suppressed signal intensity, a finding that indicates fat
deposition.22

13. • Fig SK 10-11 Rathke's cleft cyst. Coronal T1-weighted image shows a
well-defined intra- and suprasellar lesion that displaces the optic
chiasm upward (arrowheads). The high signal intensity reflects the
high concentration of mucopolysaccharides within the mass.22
(Courtesy of Yasser Regab, M.D., Cairo, Egypt.)

14. • Fig SK 10-12 Colloid cyst. Sagittal T1-weighted image
shows a well-defined, homogeneously hyperintense
suprasellar cyst (curved arrow) that displaces the optic
chiasm upward (straight arrow). Intrasellar extension
compresses the pituitary gland (arrowhead).22

15. • Fig SK 10-13 Encephalitis. Coronal T2-weighted
image shows a hyperintense area in the thalamic-
hypothalamic region (arrow) that corresponds to
edematous changes.22 (Courtesy of Yasser Regab,
M.D., Cairo, Egypt.)

16. • Fig SK 10-14 Sarcoidosis. (A) Sagittal T1-weighted image in a
black woman with recent onset of visual difficulties shows
abnormal thickening in the hypothalamic region (arrows)
involving the tuber cinereum, mamillary bodies, and
infundibulum. (B) After a 3-week course of steroids, a
repeat sagittal scan shows dramatic resolution with a
return to normal of hypothalamic region anatomy. Note the
mamillary bodies (curved arrow), tuber cinereum (straight
arrow), and infundibulum (arrowhead).21

17. • Fig SK 10-15 Ectopic posterior pituitary gland. Coronal T1-weighted
image in a young boy with short stature shows a hyperintense,
oblong nodule (arrow) in the inferior portion of the tuber cinereum.
Pituitary tissue within the sella does not show high signal in its
posterior portion, and there is no evidence of an infundibulum
connecting the pituitary gland to the hypothalamus.21

18. • Fig SK 10-16 Wernicke's encephalopathy.
Sagittal T1-weighted image in an elderly
alcoholic man shows striking atrophy of the
mamillary bodies.21