Two patients presenting with headache and radiological features of an enlarged sella turcica were found to have the primary empty sell syndrome. Whilst under observation, 1 patient developed papilloedema and was shown to have benign intracranial hypertension. The second patient also had raised intracranial pressure. A relationship between the empty sella syndrome and benign intracranial hypertension has previously been reported and it is suggested that in a patient with a congenitally incompetent diaphragma sella, chronically raised intracranial pressure caused herniation of the subarachnoid space into the sella turcica. Subsequently, sella turcica enlargement and remodelling occurs, sometimes with endocrine, visual and other sequelae. The clinical, radiological and CT scan features of the empty sella syndrome are discussed and the indications for major radiological studies are considered.