Case Of the Week (COW) 03 January 2016
PAPILLEDEMA DUE TO SUPERIOR SAGITTAL SINUS THROMBOSIS
Findings
Bilateral Perioptic subarachnoid space distension with optic nerve tortuosity and optic disc flattening is noted , reflecting papilledema . There is absent flow void in the superior sagittal sinus in Axial T2W1 and Coronal FLAIR images consistent with Thrombus . TIWI sag images showed the hyperintense thrombus in the superior sagittal sinus. MR Venogram revealed no flow in the superior sagittal sinus.
Discussion
Direct transmission of the elevated CSF pressure results in distension of the perioptic subarachnoid space and ballooning of the optic papilla, causing it to protrude physically into the posterior aspect of the globe Papilledema due to increased CSF in the absence of mass lesion on brain imaging is associated with the term Pseudotumor Cerebri (PTC). Current literature based on clinical experiences and advances in neuroimaging technology supports the terminology of Idiopathic Intracranial Hypertension (IIH). In papilledema the acquired bilateral, occasionally asymmetrical, ONH swelling is due to increased intracranial pressure. The term papilledema must be strictly reserved for optic disc edema as a result of increased CSF, which has specific etiologies. The most important entity to consider in cases of increased intracranial pressure is a space occupying lesion of the brain. However ,Intracranial Hypertension can be Secondary to: Superior Saggital Sinus Thrombosis Chiari I Malformation Arteriovenous Malformation Meningitis/Encephalitis. MRI is crucial to rule out causes of Pappilledema, like in our case.
Contributed By:
Prof. S. Babu Peter
Barnard Institute of Radiology
PAPILLEDEMA DUE TO SUPERIOR SAGITTAL SINUS THROMBOSIS
Findings
Bilateral Perioptic subarachnoid space distension with optic nerve tortuosity and optic disc flattening is noted , reflecting papilledema . There is absent flow void in the superior sagittal sinus in Axial T2W1 and Coronal FLAIR images consistent with Thrombus . TIWI sag images showed the hyperintense thrombus in the superior sagittal sinus. MR Venogram revealed no flow in the superior sagittal sinus.
Discussion
Direct transmission of the elevated CSF pressure results in distension of the perioptic subarachnoid space and ballooning of the optic papilla, causing it to protrude physically into the posterior aspect of the globe Papilledema due to increased CSF in the absence of mass lesion on brain imaging is associated with the term Pseudotumor Cerebri (PTC). Current literature based on clinical experiences and advances in neuroimaging technology supports the terminology of Idiopathic Intracranial Hypertension (IIH). In papilledema the acquired bilateral, occasionally asymmetrical, ONH swelling is due to increased intracranial pressure. The term papilledema must be strictly reserved for optic disc edema as a result of increased CSF, which has specific etiologies. The most important entity to consider in cases of increased intracranial pressure is a space occupying lesion of the brain. However ,Intracranial Hypertension can be Secondary to: Superior Saggital Sinus Thrombosis Chiari I Malformation Arteriovenous Malformation Meningitis/Encephalitis. MRI is crucial to rule out causes of Pappilledema, like in our case.
Contributed By:
Prof. S. Babu Peter
Barnard Institute of Radiology