MR imaging of idiopathic intracranial hypertension

Abstract

We report the case of a 9-year-old male patient with idiopathic intracranial hypertension without papilledema for which MR imaging of the optic nerves and pituitary gland provided important clues for the diagnosis of idiopathic intracranial hypertension and showed a return to normal appearance after normalization of CSF pressure.

Figures

fig 1.

MR images from the case of a 9-year-old male patient with IIH without papilledema. A, Transverse T2-weighted image (4000/96/2 [TR/TE/excitations]), obtained at admission, shows small cortical veins and superior sagittal, straight, transverse and sigmoid sinuses but no intracranial mass lesion, ventricular dilation, or sinus thrombosis. B, Sagittal fat-saturated T2-weighted image (4000/100/2) of the right optic nerve, obtained at admission, shows flattening of the posterior sclera, vertical tortuosity and elongation of the nerve, and distension of the perioptic subarachnoid space. C, Sagittal T1-weighted image (500/9/2), obtained at admission, shows a partially empty sella. D, Transverse T2-weighted image, obtained 4 months after admission and after three lumbar punctures and improvement of the clinical symptomatology, reveals a decrease in the subarachnoid space and normalization of the sizes of the cortical veins and superior sagittal, straight, transverse, and sigmoid sinuses. E, Sagittal fat-saturated T2-weighted image of the right optic nerve, obtained 4 months after admission and after three lumbar punctures and improvement of the clinical symptomatology, shows a normally round orbit and a normally straight nerve. F, Sagittal T1-weighted image, obtained 4 months after admission and after three lumbar punctures and improvement of the clinical symptomatology, shows that the previously compressed pituitary gland had reexpanded to fill the sella turcica.