Conventional and Diffusion-Weighted Magnetic Resonance Imaging Findings in a Pediatric Patient with a Posterior Fossa Brain Tumor and Papilledema

Abstract

We present a case report of a 21-month-old female patient to highlight magnetic resonance (MR) imaging findings associated with papilledema in a pediatric patient with an intracranial tumor. The MR findings included optic disc elevation, dilated perioptic subarachnoid spaces, optic nerve tortuosity and restricted diffusion in the optic nerve heads, all of which resolved upon resolution of raised intracranial pressure (ICP) and papilledema. The case demonstrates that both conventional and diffusion-weighted MR imaging findings can detect the presence, and follow posttreatment resolution, of increased ICP and papilledema in a pediatric tumor patient. The postoperative resolution of optic disc elevation clearly indicates the intracranial tumor etiology.

Hyperintense Optic Nerve Heads on Diffusion-Weighted Imaging: A Potential Imaging Sign of Papilledema

“…2 This suggests that the diffusion restriction may not be a marker of irreversible damage secondary to ischemia but, instead, may be a marker of a metabolic disruption, which may resolve with treatment of the increased pressure. In this case, this sign of papilledema may turn out to be reversible, as with several of the other imaging signs of papilledema.…”

“…We have anecdotally observed hyperintensity of the ON head on DWI in some cases of clinically proven papilledema. Although this has been previously described in a case report, 2 the ability of this sign to distinguish patients with papilledema from healthy control participants has not been systematically studied. The purpose of this study is to evaluate whether hyperintensity of the ON head on DWI is statistically more likely to occur in patients with clinically proven papilledema than in unaffected control participants.…”

“…[1][2][3] Although MR imaging is primarily used in an attempt to elucidate the cause of the papilledema, MR imaging may, at times, provide the first indication of underlying papilledema, particularly in those patients with headache in whom fundoscopic examination has not yet been performed or has not been able to detect papilledema given its less-than-perfect sensitivity because of factors such as patient cooperation and examiner skill. 4,5 This ability of MR imaging to identify otherwise unsuspected papilledema is especially important in patients with idiopathic intracranial hypertension, in whom the diagnosis often hinges on the recognition of papilledema.…”

Optic Disc Edema From Papilledema

“…1 Papilledema resulting from an intracranial mass is dependent on the location of the mass and its rate of growth. 53,54 For example, infratentorial tumors commonly disrupt cerebrospinal flow through the cerebral aqueduct and are much more likely than supratentorial tumors to be associated with papilledema. Tumors that grow in a slow, progressive manner are also much more likely to produce papilledema than those that grow rapidly.…”