Idiopathic Intracranial Hypertension: MRI

Case Report: 35 yr old male with headache and bilateral papilloedema  on fundoscopy shows Empty sellaturcica with CSF pocket , perioptic nerve CSF column prominence ,  redundancy of the optic nerve, post scleral flattening with unremarkable lens/ extra ocular muscles / orbital apices/ dural sinuses flow voids on axial T2 suggesting idiopathic intracranial hypertension. Associated multiple white matter altered signals   with no slit like ventricles/ meningoceles is sometimes known to be associated with IIH .

Teaching points by Dr MGK Murthy

MRI technologist: Mr Hari

1.IIH  aetiology poorly understood , may be sure to defective CSF absorption/ excessive production/ combination  or increased intravascular volume or increased intravenous pressures etc .Neurological exam reveals normal study except 6th nerve palsy sometimes 

2. CSF pressure at opening on lumbar puncture high, with intermittent spikes with major flow  normal pressure (<35mmHg)

3. spontaneous out pouchings of dura (meningocele) particularly at petrousapex, CSF leaks through nose/ ear etc  may be noted 

4.Associated conditions include endocrine/ drugs(Doxycycline) / SLE/ CRF/ Dural sinus stenosis  etc 

5.Other findings could be  reveal bilateral smooth stenoses of the lateral segments of the transverse sinuses (no evidence of current or remote thrombosis /prominent arachnoid pits (lateral sphenoid) /small menigoceles / CSF leaks 

6.Associatd whitemater lesions could be explained by defective CSF absorption and transependymal seepage of CSF 

7.Treatment include  Diamox  or   repeated letting out CSF or shunting etc