Idiopathic intracranial hypertension

Findings: Asymmetry of the lateral ventricles mild bulkiness to the left thalamus. No definite mass identified. A vessel traversing the inferior right frontal lobe extending to the anterior horn of the right lateral ventricle in keeping with a developmental venous anomaly. The optic nerves are distended bilaterally with associated proptosis. This could be further evaluated with MRI.

The venous sinuses enhance normally without evidence of dural venous sinus thrombosis. No intra or extra-axial hemorrhage is seen.

Findings: Asymmetric lateral ventricles again noted without any underlying abnormality or abnormal signal; no "slit ventricles". No intra or extra-axial collection, mass or focal abnormality.

No restricted diffusion. No evidence of previous infarction or hemorrhage. No abnormal contrast enhancement.

Dilatation and mild tortuosity of both extra-cranial optic nerve sheaths. No abnormal T2/STIR or post contrast enhancement of the optic nerve. Partially empty sella. Increased nuchal fat noted.

MRV - no evidence of venous sinus thrombosis but typical and marked focal narrowing of the transverse sinuses laterally.

Technique: The procedure was explained to the patient and informed consent obtained. Prone position. Aseptic technique. Administration of local anesthetic (Lignocaine 1%) to the skin. Under fluoroscopy guidance, a 22 gauge spinal needle was directed to the L4/L5 space. Clear CSF was obtained and 5 samples were sent for routine pathology. Opening pressure was 24cm H20. Procedure was well tolerated by the patient and there were no immediate complications.

Conclusion: Mildly elevated opening CSF pressure and an uncomplicated L4/5 lumbar puncture.