Presentation
Headache 3/12. Bilateral papilledema one month.
Patient Data
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.
CSF opening pressure was 24 cm H2O on fluoroscopic guided lumbar puncture.
Case Discussion
Dilatation and tortuosity of both extra-cranial optic nerves, partially empty fossa, pinched transverse sinuses and increased subcutaneous fat are typical features of idiopathic intracranial hypertension, which was the discharge diagnosis for this patient.
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