We read with interest the “Images in Neurology” contribution from Frassanito et al,1 and we have some comments about their observations. Primary empty sella syndrome is often asymptomatic; more than 80% of patients in one series were endocrinologically normal,2 and headache only occurred in 10% of patients in another series.3 Papilledema or other visual disturbances are even less common. The diagnosis of primary empty sella requires that previous adenoma with infarction, infection, and trauma be excluded. The authors seem to use the term “primary empty sella syndrome” interchangeably with idiopathic intracranial hypertension (IIH) or pseudotumor cerebri (see the first sentence in the “Comments” section concerning pseudotumor cerebri in the Frassanito et al article1); however, this is misleading. An empty sella is present in approximately 70% of patients with IIH;4 however, this radiographic finding does not indicate IIH or pertain to the current intracranial pressure.
Eggenberger E, Cornblath WT. “Blinding” Empty Sella. Arch Neurol. 2012;69(8):1083–1084. doi:10.1001/archneurol.2012.1135
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