Idiopathic intracranial hypertension

Case contributed by Dr Mahmoud Yacout Alabd

Presentation

Headache, vomitting and photophobia. Fundal examination revealed papilledema.

Patient Data

Age: 31 y
Gender: Female
Modality: MRI

Widened partially empty sella with  compressed pituitary tissue.

Narrowed lateral ventricles notably the anterior horns with slit-like appearance.

Exaggerated subarachnoid fluid surrounding both optic nerves with bulging optic discs and abnormal concavity of the posterior scleral surface. (findings associated with papilloedema regardless of the cause).

Smooth attenuation of the lateral aspects of both transverse sinuses, also another consequent to increased intra cranial pressure.

No focal lesions identified or any structural abnormality that can explain the increased intracranial pressure and the associated paplloedema.

Modality: Annotated image

Typical findings of IIH.

Case Discussion

Idiopathic intracranial hypertension is a syndrome of unknown etiology. The diagnosis is usually achieved by exclusion of other pathologies aided with clinical findings and patient's complaints. Unlike other conditions associated with mechanical or pathological CSF obstruction where the ventricular system is ballooned and dilated, in IIH the ventricles (classically the anterior horns of the lateral ventricles) are compressed and slit like due to compression by the globally increased pressure. Other classical findings are partially empty sella turcica, flattening of the posterior scleral surface, dilated subarachnoid spaces around the optic nerves and smooth narrowing of the lateral aspects of the transverse sinuses with no underlying thrombosis or occlusion on MRV.

The diagnosis was later confirmed by lumbar puncture that showed increased opening pressure.

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Case Information

rID: 41676
Case created: 14th Dec 2015
Last edited: 22nd Dec 2015
Inclusion in quiz mode: Included

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