Intracranial hypertension (pseudotumor cerebri)
5 weeks of headaches. Morning and on stooping. Papilledema.
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The pituitary fossa is partially empty, unusual in this age group. Optic nerve sheaths are prominent bilaterally.
The right transverse and sigmoid sinus is larger than the left, with stenosis seen at the junction with the sigmoid sinus. Flow demonstrated throughout the major dural venous sinuses. No abnormal signal seen within the dural venous sinuses.
No abnormal parenchymal signal detected. The ventricles and sulcal pattern normal. No abnormal diffusion restriction detected. Incidental right maxillary sinus mucous retention cyst.
Although subtle the changes are consistent with idiopathic intracranial hypertension (pseudotumor cerebri), confirmed with high opening pressures on LP.
Patient was treated with a lumboperitoneal shunt which improved symptoms. Remains well 3 years later.