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NEUROIMAGE
Year : 2012  |  Volume : 60  |  Issue : 2  |  Page : 267-268

Reversal of MRI findings following CSF drainage in idiopathic intracranial hypertension


1 Department of Radiodiagnosis, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication19-May-2012

Correspondence Address:
Prasant Peter
Department of Radiodiagnosis, Christian Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.96440

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How to cite this article:
Peter P, Philip N, Singh Y. Reversal of MRI findings following CSF drainage in idiopathic intracranial hypertension. Neurol India 2012;60:267-8

How to cite this URL:
Peter P, Philip N, Singh Y. Reversal of MRI findings following CSF drainage in idiopathic intracranial hypertension. Neurol India [serial online] 2012 [cited 2021 Sep 20];60:267-8. Available from: https://www.neurologyindia.com/text.asp?2012/60/2/267/96440


A 22-year-old thin male presented with holocranial headache and painless, non-progressive loss of vision bilaterally. On examination, visual acuity was 6/9 on both sides and he had 6 th cranial nerve palsy on the left side with bilateral papilledema. No other neurological deficits were present. Magnetic resonance imaging (MRI) showed normal brain parenchyma and ventricles. There was buckling of bilateral optic nerves with increased perineural fluid, partial empty sella with postero-inferiorly displaced infundibulum, and poor visualization of left transverse sinus on venography [Figure 1]. A diagnosis of idiopathic intracranial hypertension (IIH) was considered and the patient underwent cerebrospinal fluid (CSF) drainage. Opening CSF pressure was borderline high (220 mmH2O). All other investigations, including CSF analysis, were normal. A repeat MRI was done which showed reversal of both partial empty sella as well as optic nerve buckling with improved visualization of left transverse sinus [Figure 2]. By day 8, there was significant relief in symptoms and he was discharged on acetazolamide and advised follow-up.
Figure 1: MRI (sagittal T2, sagittal FATSAT, and venography) shows the partial empty sella (single arrow), buckled optic nerve with perineural fluid (double arrow), and the poorly visualized left transverse sinus (triple arrow)

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Figure 2: Repeat MRI (2 days after CSF drainage) shows reversal of the partial empty sella (single arrow), straightened optic nerve (double arrow), and better visualization of the left transverse sinus (triple arrow)

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IIH is a headache syndrome characterized by raised intracranial pressure, absence of intracranial mass lesion or ventricular dilatation, and normal consciousness and CSF composition. [1] The syndrome is most common in obese young women due to increased CSF secretion secondary to high levels of estrogens. [2] Although CSF pressure is usually raised, studies have reported patients with normal mean pressure and only intermittent spikes. [3] Reversal of MRI findings as seen in this patient can help confirm the diagnosis in these patients.

 
  References Top

1.Soler D, Cox T, Bullock P, Calver DM, Robinson RO. Diagnosis and management of benign intracranial hypertension. Arch Dis Child 1998;78:89-94.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Donaldson JO. Pathogenesis of pseudotumour cerebri syndromes. Neurology 1981;31:877-80.  Back to cited text no. 2
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3.Skau M, Brennum J, Gjerris F, Jensen R. What is New About Idiopathic Intracranial Hypertension? An Updated Review of Mechanism and Treatment. Cephalalgia 2006;26:384-99.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  


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