The use of contrast in MRV depends on institutional preferences. Arteriography There is no role for arteriography in patients with primary headache and no concerning findings on clinical or physical examination. Another diagnosis to consider in patients with headache and papilledema is pseudotumor cerebri, also known as pseudotumor cerebri syndrome (PTCS). Primary PTCS is also known as idiopathic intracranial hypertension. This disorder typically manifests as severe headaches and visual impairments and prevails in overweight females of childbearing age but can occur in obese males and prepubertal thin girls and boys. Its incidence is rising in parallel with the obesity epidemic. The etiology of pseudotumor cerebri is unclear, with impaired cerebrospinal fluid (CSF) homeostasis and altered venous hemodynamics the proposed mechanisms for elevated intracranial pressure. A study by Alperin et al [33] supported these mechanisms by demonstrating a reduced relative cerebral drainage through the internal jugular vein with an increased intracranial CSF volume that accumulates in the subarachnoid space. Secondary PTCS is a result of cerebral venous abnormalities such as thrombosis, medications such as vitamin A, and medical disorders such as endocrinopathies [34]. In cases of suspected PTCS, MRI of the brain with and without contrast should be performed as MRI is more sensitive for detection of secondary signs of increased intracranial pressure such as an empty sella, dilated optic sheaths, tortuous or enhancing optic nerves, and flattening of the posterior aspects of the globes. MRI reveals more details of the intracranial structures without radiation and is better able to evaluate for meningeal infiltration and isodense tumors over CT. In patients without PTCS, MRI should reveal normal brain parenchyma without evidence of hydrocephalus, mass, or structural lesion and no abnormal meningeal enhancement.
Headache Child PCAs. The use of contrast in MRV depends on institutional preferences. Arteriography There is no role for arteriography in patients with primary headache and no concerning findings on clinical or physical examination. Another diagnosis to consider in patients with headache and papilledema is pseudotumor cerebri, also known as pseudotumor cerebri syndrome (PTCS). Primary PTCS is also known as idiopathic intracranial hypertension. This disorder typically manifests as severe headaches and visual impairments and prevails in overweight females of childbearing age but can occur in obese males and prepubertal thin girls and boys. Its incidence is rising in parallel with the obesity epidemic. The etiology of pseudotumor cerebri is unclear, with impaired cerebrospinal fluid (CSF) homeostasis and altered venous hemodynamics the proposed mechanisms for elevated intracranial pressure. A study by Alperin et al [33] supported these mechanisms by demonstrating a reduced relative cerebral drainage through the internal jugular vein with an increased intracranial CSF volume that accumulates in the subarachnoid space. Secondary PTCS is a result of cerebral venous abnormalities such as thrombosis, medications such as vitamin A, and medical disorders such as endocrinopathies [34]. In cases of suspected PTCS, MRI of the brain with and without contrast should be performed as MRI is more sensitive for detection of secondary signs of increased intracranial pressure such as an empty sella, dilated optic sheaths, tortuous or enhancing optic nerves, and flattening of the posterior aspects of the globes. MRI reveals more details of the intracranial structures without radiation and is better able to evaluate for meningeal infiltration and isodense tumors over CT. In patients without PTCS, MRI should reveal normal brain parenchyma without evidence of hydrocephalus, mass, or structural lesion and no abnormal meningeal enhancement.