ABSENT SEPTUM PELLUCIDUM: IS IT IMPORTANT
Abstract
The absent septum pellucidum on imaging was thought to be normal variation when present alone. On the review of reported cases, however, it has been reclaimed that this finding alone is very rare. We reviewed the 204 reported cases of absent septum pellucidum (ASP) with other associated anomalies from 1978 through 1998. There are only six cases reported to have ASP alone. Two of them were schizophrenic. Most of the cases were associated with septo-optic-hypothalamic dysplasia. There were 26 cases associated with other anomalies of mid-line defect and 4 cases with migrational or differentiation anomalies of neurones. Some authors claimed that the findings may only indicate the timing of a congenital insult. Many reports showed cases of only ASP on imagings in patients with clinically proven to have optic nerve hypoplasia and/or hypothalamic-pituitary dysfunction. This implied that the abnormality of optic nerve and hypothalamic-pituitary axis are out of sensitivity of the imagings to be demonstrated. We believe that when an ASP is found on the imaging, the searching for other associated anomalies should be done carefully eventhough nothing else are demonstrated, emphasizing clinician to evaluate clinical abnormalities of optic nerve and hormonal dysfunction should be done.
Radiologists, who work in the field of neuroimagings either computed tomography (CT) or magnetic resonance imagings (MRI) of brains, at least once have seen the septum pellucidum loss. They might have a question whether it is important. If there are other associated anomalies, the question may be easy. But if it is found alone, the other questions will follow. In the past, the absent septum pellucidum (ASP) alone on CT was thought to be normal variation or not to have any significant in clinical course. After studying by MRI, it has been found that ASP alone is very rare. This article is emphasized in the significant of the septum pellucidum in human nervous system and radiologic points to help the clinicians dealing with these patients.
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