Presentation
Headache, vomitting and photophobia. Fundal examination revealed papilledema.
Patient Data
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 papilledema 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.
Typical findings of idiopathic intracranial hypertension.
Slit-like anterior horns of both lateral ventricles.
Concave shaped mildly bulging optic disc (black arrows). Prominent subarachnoid space related to the optic nerves, left side is shown in this image (white arrow).
Widened partially empty sella.
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 idiopathic intracranial hypertension 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.