PNR Head 22
History
17 yo obese F with one week of headaches and
blurred vision, papilledema, and elevated
opening pressures on lumbar puncture
Major Findings
- Partially empty sella, which can be a sign of idiopathic intracranial hypertension
- Right medial orbital wall dehiscence (likely a chronic fracture) with partial herniation of the thickened right medial rectus muscle
Teaching Points
Idiopathic intracranial hypertension (IIH) is typically thought of as a diagnosis in middle-aged, obese females but can also occur in obese children. Suggestive findings include:
- Partially empty and expanded sella turcica
- Prominent Meckel's cave
- Enlarged and tortuous optic nerve sheaths with flattened optic discs (difficult to see on CT)
- Stenotic venous sinuses
When we see an enlarged and herniated extraocular muscle, we can suggest the possibility extraocular muscle entrapment and recommend ophthalmologic correlation, however this is a clinical diagnosis and cannot be diagnosed via imaging.
Accession: CL0630
Study description: CT HEAD W/O CONTRAST
