MedPix Medical Image Database COW - Case of the Week Case Contributor: Steven J Goldstein Affiliation: University of Kentucky.

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Presentation transcript:

MedPix Medical Image Database COW - Case of the Week Case Contributor: Steven J Goldstein Affiliation: University of Kentucky

MedPix No: History Pt Demographics: Age = 50 y.o. Gender = woman 50 year old woman with headaches and blurred vision for 1 month. Downloaded by (-1)

MedPix No: EXAM & LABS Obese womanPapilledema with elevated optic discs.

Empty Sella from pseudotumor cerebri (bilateral Transverse sinus stenoses) Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Cerebral Pseudotumor with bilateral Transverse sinus stenoses Empty Sella (subarachnoid space * herniating into pituitary fossa) - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - SS - Sphenoid Sinus - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Dilated optic nerve sheaths (arrows) due to increased CSF volume/pressure. Bilateral transverse sinus stenoses on MRV. Cerebral peduncle (CP) Quadrigeminal plate (arrowheads). - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Dilated optic nerve sheaths (arrows) due to increased CSF volume/pressure. Bilateral transverse sinus stenoses on MRV. - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Pseudotumor cerebri, transverse sinus stenosis Empty Sella, pituitary stalk (arrowhead). Also labeled: - arrows - normal enhancement of lacrimal glands - crbll - cerebellum - lat - lateral rectus muscle - med - medial rectus muscle - pons - brainstem - temporal - lobe - - Downloaded by (-1)

Transverse sinus stenosis (bilateral), Pseudo tumor Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Transverse sinus stenosis (bilateral), Pseudo tumor Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

Transverse sinus stenosis (bilateral) Slightly oblique 3D MRV showing bilateral transverse sinus stenoses (arrows) on MRV. IJV = Internal Jugular Vein. Also labeled, the ascending superficial vein of Trollard (vertical, connecting to superior sagittal sinus. - - Downloaded by (-1)

Transverse sinus stenosis (bilateral), Pseudo tumor Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - Downloaded by (-1)

Transverse sinus stenosis (bilateral), Pseudo tumor Bilateral transverse sinus stenoses on MRV (arrows) - Downloaded by (-1)

Transverse sinus stenosis (bilateral), Pseudo tumor Empty Sella - Dilated optic nerve sheaths due to increase CSF volume/pressure. Bilateral transverse sinus stenoses on MRV - - Downloaded by (-1)

*Idiopathic* Intracranial Hypertension Bilateral transverse sinus stenoses (arrows) on MRV. - - Downloaded by (-1)

FINDINGS Empty Sella Dilated optic nerve sheaths due to increase CSF volume Bilateral transverse sinus stenoses on MRV

DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Optic neuritis - Hydrocephalus - Intracranial hypertension - Sinus Thrombophlebitis

Diagnosis: Pseudotumor cerebri (idiopathic intracranial hypertension) Dx Confirmed by: MRI, MRV, and clinical examination

DISCUSSION Pseudotumor cerebri is increased intracranial pressure NOT caused by a mass lesion. It may result from increased CSF presure with or without increased venous pressure. Some cases, like this one, are associated with stenosis of the large dural sinuses. - - PMID: PMID: acranial/hypertension/info/C