Idiopathic intracranial hypertension

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

One month severe frontal headache with nausea, photophobia and phonophobia

Patient Data

Age: 35 years
Gender: Female

MRI

The findings include a partially empty sella, with the pituitary gland flattened against the wall of the sella, slightly distension of optic nerve sheath complex bilaterally, without tortuous optic nerves, in conjunction with a focal posterior flattening of the globes at the insertion of the optic nerves. There is also a cerebellar tonsillar ectopia of 3.5 mm below the foramen magnum.

MR venography reveals focal stenosis of the lateral aspect of both transverse sinuses, more prominent on the right side, and excludes cerebral sinus thrombosis.

There is no evidence of hydrocephalus, mass, structural vascular lesion, and no abnormal meningeal enhancement.

Conclusion:

These imaging patterns are consistent with the diagnosis of idiopathic intracranial hypertension (IIH).

Lumbar puncture

The patient underwent a lumbar puncture, for CSF testing, which indicated an elevated opening pressure of 40 cm CSF, and normal CSF composition.

Case Discussion

Idiopathic intracranial hypertension (IIH) is a disease defined by an increase of intracranial pressure of unexplained cause, which manifests predominantly in overweight women of childbearing age 1-7. MRI and MR cerebral venography are essential tools for the diagnosis of clinically suspected IIH 1-7. Transverse sinus stenosis is the most sensitive finding of this disease. 1,4,7.

The diagnosis of idiopathic intracranial hypertension, in this case, was based on a combination of clinical presentation, brain imaging findings, and a lumbar puncture that indicated elevated opening pressure.

Case courtesy of:

  • Sterfferson Morais, MD - PGY-3, radiology resident, Department of Radiology
  • Antonio Rodrigues de Aguiar Neto, MD - radiologist, Department of Radiology

Hospital da Restauração – Recife, PE – Brazil

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Case information

rID: 75073
Published: 15th Mar 2020
Last edited: 17th Mar 2020
Inclusion in quiz mode: Included
Institution: Real Hospital Português de Pernambuco - Recife, PE - Brazil

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