Pseudotumor Cerebri

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

“…58 Some of the earliest radiologic investigations of PTC demonstrated evidence of decreased ventricle size and sella turcica demineralization, thought to be a late manifestation of increased ICP, on plain film skull x-ray examination. 59 The concept of decreased ventricle size as a sign of PTC emerged from these early studies. 11,45 Early CT studies enabled clinicians to evaluate intracranial masses before lumbar puncture.…”

“…45,62 It was 1 of the first signs noted on plain film x-ray examination and subsequently on early MR imaging studies. 59,63 The term "empty sella" should be reserved for studies in which the pituitary gland is not visible, and these cases tend to be later manifestations of increased ICP. 64 There is a wide spectrum of pituitary height changes; thus, many cases of empty sella may, in fact, be better described as a partially empty sella or a compressed pituitary gland.…”

“…66 This finding was first noted in older studies using ventriculography and also in early CT studies, but it appears to be an insignificant finding of little clinical use now. 45,58,59 MR Venography Previously, it was thought that MR venography should be reserved for use in atypical (eg, male, normal weight) patients to rule out sinovenous thrombosis. 76 Now, many authors propose that any patient with suspected elevated intracranial hypertension undergo MR venography in addition to traditional MR orbital imaging to evaluate venous thrombosis or stenosis as the etiology of PTC symptoms.…”

CSF imaging in benign intracranial hypertension

“…In 1914 Nonne introduced the term 'pseudotumor cerebri'. Pneumoencephalographic reports by Davidoff and Dyke, some 20 years later, documented that this syndrome occurs in the presence of an anatomically normal ventricular system, although a certain percentage of these patients will have 'small' ventricles (Jacobson and Shapiro, 1964). Bercaw and Greer (1970) and Schlesinger et al (1965) have described a CSF image pattern of delayed movement of 131I human serum albumin with persistent concentration of radiopharmaceutical in the parasagittal area on delayed views (24 hours).…”

“…Generalized distribution of radiopharmaceutical over the cerebral convexities is present with concentration in the parasagittal area superiorly and anteriorly. 1053 pression and CSF diversionary shunting (Jacobson and Shapiro, 1964). Skull radiographs, cerebral angiograms, and pneumoencephalograms have been employed in the diagnostic examination of these patients and the findings described.…”