Case 23 - Pseudotumor Cerebri, CT, CTV

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Report

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Severe headaches waking from sleep, hypertension, migraine history

Technique: Sagittal T1 weighted, axial T2 weighted, axial FLAIR, axial diffusion weighted scans, with and without susceptibility weighted sequences were performed through the brain. No immediate complications were noted. ADC maps were constructed from the axial diffusion weighted scans after 3D post-processing from raw data.

Findings:

These images demonstrate a partially empty sella. There is dilatation of the optic nerve sheath complex bilaterally with imaging findings suggestive of mild papilledema. There is dilatation of the Meckel's cave region dural enlargement.

No focal masses are seen in the brain.

There are punctate areas of high signal intensity in the subcortical white matter.

IMPRESSION:

Imaging findings suggestive of idiopathic intracranial hypertension (pseudotumor cerebri) based on optic nerve sheath dilatation, mild papilledema, and dilatation of the dural spaces including partially empty sella. Recommend corroboration with opening pressure sampling.

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CTA Head, CTV head 9/3/2019 6:44 PM

INDICATION: Pseudotumor cerebri
COMPARISON: MRI brain 3/30/2019 (Report above)

TECHNIQUE: Axial computed tomographic images of head were obtained after the administration of intravenous contrast, using approximately 70 mL of Omnipaque 350.

FINDINGS:
CTA HEAD: The anterior and middle cerebral arteries are patent. There is a normal anterior communicating artery. The basilar artery is patent. There is a near complete fetal origin of the left posterior cerebral artery. The posterior cerebral arteries are patent. No intracranial arterial aneurysm. No abnormally enhancing parenchyma or mass seen.

CTV HEAD: The superior and inferior sagittal sinuses are patent. The straight sinus and confluence sinuses are patent. Gradual tapering and stenosis of the distal transverse sinuses bilaterally about the origin of the sigmoid sinuses, moderate on the left and mild-to-moderate on the right. Contrast opacification is seen within the proximal jugular veins bilaterally.

IMPRESSION:
1. Tapering the appearance of both transverse sinuses with moderate narrowing distally on the left and mild to moderate narrowing on the right. No dural venous sinus thrombosis.

2. Patent intracranial arterial vasculature. No intracranial arterial aneurysm.

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University