Article Figures & Data
Figures
- Fig 1.
This 31-year-old woman presenting with headache is found to have an empty sella on sagittal T1-weighted MR imaging.
- Fig 2.
A narrowed right transverse sinus is noted in this 32-year-old woman, seen on MR venography, in addition to ONS enlargement and a partially empty sella on axial MR imaging.
- Fig 3.
Protrusion of the right optic nerve head and horizontal tortuosity of the optic nerve are seen in this 21-year-old woman on axial T2-weighted MR imaging. Clinically, the patient presented with headaches, vision changes, and papilledema noted on examination.
- Fig 4.
A, The ONS is widened with expanded CSF hyperintensity surrounding the optic nerve, seen on axial T2-weighted MR imaging in conjunction with posterior flattening of the globes. ONS widening is thought to coincide with papilledema, which is seen in this 27-year-old woman who presented with headaches. B, Coronal T2-weighted MR imaging in a 55-year-old woman with headache demonstrates increased peri-ONS space marked by hyperintense signal intensity surrounding the optic nerve.
Tables
Medical disorders Addison disease
Hypoparathyroidism
Chronic obstructive pulmonary disease
Right heart failure with pulmonary hypertension
Obstructive sleep apnea
Pickwickian syndrome
Polycystic ovary syndrome
Systemic lupus erythematosus
Uremia
Severe iron deficiency anemia
Medications Tetracycline and related compounds (minocycline, doxycycline)
Vitamin A (at doses >25 000 IU daily) and related compounds (isotretinoin [Accutane], vitamin supplements, excessive intake of liver, all-trans retinoic acid)
Anabolic steroids
Corticosteroid withdrawal following prolonged administration
Growth hormone administration in deficient patients
Nalidixic acid
Lithium
Oral contraceptive use
Levonorgestrel implant system
Amiodarone
Cyclosporine
Cytarabine
Obstruction to venous drainage Cerebral venous sinus thrombosis
Jugular vein thrombosis
Superior vena cava syndrome
Jugular vein ligation following bilateral radical neck dissection
Increased right heart pressure
Glomus tumor
Compression by tumor process (eg, meningioma)
Infections HIV infection, borreliosis
Postvaricella infection in children
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↵a Adapted from Friedman and Jacobson,7 Szitkar,8 Wall,22 and Alperin et al.79
1) If symptoms are present, they may only reflect those of generalized intracranial hypertension or papilledema 2) If signs are present, they may reflect only those of generalized intracranial hypertension or papilledema 3) Documented elevated ICP measured in the lateral decubitus position (findings of assessment of ICP by lumbar puncture are considered abnormal if above 20 cm H2O in normal-weight individuals and 25 mm H2O in obese individuals20); MRI abnormal if above 20 cm H2O in normal-weight individuals and 25 mm H2O in obese individuals20) 4) Normal CSF composition 5) No evidence of hydrocephalus, mass, structural, or vascular lesion on MRI or contrast-enhanced CT for typical patients and on MRI and MR venography for all others 6) No other cause of intracranial hypertension identified -
↵a Adapted from Friedman and Jacobson.7
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Proximal Etiology Result Increased interstitial fluid (ISF) volume Increased cerebral volume Increased blood volume Increased tissue volume Increased CSF production rate Increased CSF volume Increased CSF outflow resistance Loss of cerebral autoregulation Increased cerebral arterial pressure Increased cerebral venous pressure Increased venous blood volume and increased ISF Reduced CSF outflow and increased CSF volume -
↵a (Adapted from Walker.10)
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References Sensitivity Specificity Empty sella Agid et al, 200666 26.7% 94.6% Yuh et al, 200064 2.5% Partially empty sella/decreased pituitary height Agid et al, 200666 53.3% 75% Yuh et al, 200064 80% 92% Brodsky and Vaphiades, 199862 70% Flattened posterior globe/sclera Agid et al, 200666 43.3% 100% Brodsky and Vaphiades, 199862 80% Jinkins et al, 199671 66.7% Enlarged ONS (perioptic subarachnoid space) Agid et al, 200666 66.7% 82.1% Brodsky and Vaphiades, 199862 45% Increased tortuosity of optic nerve Agid et al, 200666 40% 91.1% Brodsky and Vaphiades, 199862 40% Enhancement of optic nerve Agid et al, 200666 6.7% 98.2% Brodsky and Vaphiades, 199862 50% Intraocular protrusion of optic nerve head Agid et al, 200666 3.3% 100% Brodsky and Vaphiades, 199862 30% Slitlike ventricles Agid et al, 200666 3.3% 100%
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