Perioptic cerebro-spinal fluid transudation: case report of an unusual finding of optic hydrops in idiopathic intracranial hypertension

Abstract

Background Idiopathic intracranial hypertension (IIH) has well-described imaging findings, typically reversible with the adequate treatment. We hereby report a case of IIH with a peculiar imaging finding, that to our knowledge and by the research conducted, has never been described before—cerebro-spinal fluid (CSF) transudation across the optic nerve sheath. Case presentation A 15-year-old girl with a 2-week history of occipital headache, nausea and vomiting, diplopia, blurred vision and tinnitus in her right ear, was admitted in the neuropediatric department and after extensive diagnostic work-up was diagnosed with IIH. The MRI showed typical signs of idiopathic intracranial hypertension, including enlargement of the perioptic CSF spaces associated with a peculiar finding described as a blurred hyperintensity T2/FLAIR of the perioptic fat, which was likely related to transudation of CSF. The adequate medical therapy (including corticosteroids and acetazolamide) for 2 weeks didn’t revert the signs and symptoms and so a lumboperitoneal shunt was placed with complete resolution of the clinical picture and the imaging findings described. Conclusions The documentation of CSF transudation around the optic nerve in the setting of hydrops has never been reported before and should be recognized by the neuroradiologist. It seems to be reversible, like the other findings of IIH and its physiopathology is not clear.