From the Guidelines
This medical finding suggests you may have increased pressure inside your skull (intracranial pressure), which requires prompt medical attention to prevent potential vision damage. The report describes two related observations: fluid spaces around your optic nerves are enlarged, and the pituitary gland housing (sella turcica) appears partially empty. These are common signs of a condition called Idiopathic Intracranial Hypertension (IIH), previously known as pseudotumor cerebri, as described in the guidelines for management of IIH 1.
Key Points to Consider
- The condition typically causes headaches, vision changes, and sometimes pulsatile tinnitus (whooshing sounds in ears) 1.
- It's called "benign" because it's not caused by a tumor or life-threatening condition, though it still requires medical attention.
- You should consult a neurologist or neuro-ophthalmologist promptly for evaluation, as untreated increased pressure can potentially damage vision over time.
- They may recommend medications like acetazolamide to reduce fluid production, weight loss if applicable, and regular vision monitoring, as suggested by recent studies 1.
- The exact cause isn't always clear, but it's more common in young, overweight women and can sometimes be related to certain medications or medical conditions.
Important Considerations for Diagnosis and Treatment
- Diagnostic criteria for pseudotumor cerebri syndrome include papilledema, normal neurological examination (except sixth nerve palsy), normal brain parenchyma on imaging (with absence of mass, hydrocephalus, or abnormal meningeal enhancement), normal cerebrospinal fluid composition, and elevated lumbar puncture opening pressure 1.
- In the absence of papilledema and sixth nerve palsy, diagnosis of pseudotumor cerebri can be suggested on neuroimaging based on findings including empty sella, flattening of the posterior aspect of the globes, distention of the perioptic subarachnoid space, and transverse sinus stenosis 1.
From the Research
Definition of Terms
- Mildly dilated bilateral perioptic nerve CSF spaces refer to a condition where the cerebrospinal fluid (CSF) spaces surrounding the optic nerves are slightly enlarged on both sides.
- Partial empty sella is a condition where the sella turcica, a bony structure that houses the pituitary gland, appears partially empty on imaging studies.
- Benign raised intracranial pressure (ICT) refers to a condition where the pressure inside the skull is elevated, but not due to a malignant or life-threatening cause.
Possible Causes and Associations
- The given condition may be associated with idiopathic intracranial hypertension (IIH), a condition characterized by elevated intracranial pressure without a known cause 2, 3.
- Optic nerve sheath dilation, which can be seen in IIH, may be associated with CSF dyshomeostasis and impaired cerebral glymphatic flow 4.
- Cerebrospinal fluid congestion in the perioptic space can be caused by mass lesions extending into the optic canal, and decompressive surgery can improve visual function and reduce CSF congestion 5.
- Dilated perivascular spaces, including those surrounding the optic nerves, can be benign or pathologic, and their appearance can mimic more serious entities such as cystic neoplasms or infections 6.
Key Points to Consider
- The presence of mildly dilated bilateral perioptic nerve CSF spaces and partial empty sella may suggest underlying benign raised ICT, which could be related to IIH or other conditions.
- Further evaluation, including neuroimaging and lumbar puncture, may be necessary to determine the underlying cause of the condition and to rule out other potential causes of elevated intracranial pressure.
- Treatment for the condition will depend on the underlying cause, and may include medications such as acetazolamide, weight loss, or surgical interventions such as ventriculoperitoneal shunting 2, 3.