Transalar Encephalocele Associated with Wegener Granulomatosis and Meningeal Enhancement: Case Report

Coronal CT images (A and B) disclose the large bony defect encompassing the region of the foramen ovale and most of the left greater sphenoid wing. Axial T1- and T2-weighted images at the level of the internal auditory canal (C and D) demonstrate the transalar encephalocele presenting prolonged T1 and T2 signals and a heterogeneous lesion centered on the left maxillary antrum presumably related to the known history of Wegener granulomatosis. Sagittal T1-weighted image (E) better shows the left temporal lobe tip insinuating through the bony defect into the masticatory space. Coronal T1-weighted contrast-enhanced image with fat saturation (F) demonstrates again the encephalocele and irregular foci of contrast enhancement along the peripheral portion of the encephalocele (arrows). Axial T1-weighted contrast-enhanced images with fat saturation (G and H) show intense enhancement of the mucosa of the inspissated and inflamed left maxillary sinus. There is also linear dural thickening and enhancement of the dura within the posterior fossa along the medial aspect of the right temporal and occipital bones extending posterior to the clivus (arrowheads), possibly also related to Wegener granulomatosis. A focus of enhancement in the anterior and inferior portion of the encephalocele is again appreciated (arrow).