Pseudotumor Cerebri

Findings:

2DTOF noncontrast MRV MIP images acquired in axial, coronal, and sagittal planes demonstrate symmetric effacement of the bilateral transverse sigmoid junctions.

Differential diagnosis:

Findings of pseudotumor cerebri, technical flow related artifacts if not confirmed in multiple planes, symmetric arachnoid granulations, preexisting dural sinus stenosis of other cause including recanalized thrombosis.

Discussion:

This type of symmetric dural sinus effacement is often seen in patients with pseudotumor cerebri, AKA idiopathic intracranial hypertension and is felt to be related to extrinsic compression due to the elevated intracranial pressure. The smooth symmetric nature of these findings makes arachnoid granulations and previous thrombosis less likely. Other imaging findings associated with idiopathic intracranial hypertension include dilated optic nerve sheaths, papilledema, partially empty and enlarged sella turcica, and suymmetric small size "pinched" frontal horns. There is some overlap with normals in these findings, therefore should be taken in clinical context and correlated with elevated CSF opening pressure.

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