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### Selected Images
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*Axial T2 FS MR in a young obese female with headaches and visual symptoms shows flattening of the posterior sclera <img src='/img/arrows/CS.png'/> and minimal protrusion of the optic nerve papilla <img src='/img/arrows/CC.png'/> into the posterior globe. Note mild prominence of the CSF <img src='/img/arrows/CO.png'/> along the optic nerve sheaths.*
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*Axial T2 FS MR in a young obese female with headaches and visual symptoms shows flattening of the posterior sclera <img src='img/arrows/CS.png'/> and minimal protrusion of the optic nerve papilla <img src='img/arrows/CC.png'/> into the posterior globe. Note mild prominence of the CSF <img src='img/arrows/CO.png'/> along the optic nerve sheaths.*
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*Axial T2 FS MR in a young obese female with headaches and visual symptoms shows flattening of the posterior sclera <img src='/img/arrows/CS.png'/> and minimal protrusion of the optic nerve papilla <img src='/img/arrows/CC.png'/> into the posterior globe. Note mild prominence of the CSF <img src='/img/arrows/CO.png'/> along the optic nerve sheaths.*
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*Axial T2 FS MR in a young obese female with headaches and visual symptoms shows flattening of the posterior sclera <img src='img/arrows/CS.png'/> and minimal protrusion of the optic nerve papilla <img src='img/arrows/CC.png'/> into the posterior globe. Note mild prominence of the CSF <img src='img/arrows/CO.png'/> along the optic nerve sheaths.*
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*Axial DWI in the same patient demonstrates subtle high signal <img src='/img/arrows/CS.png'/> in the region of the optic nerve heads bilaterally. Hyperintensity of the optic nerve heads on DWI can serve as a useful imaging marker for papilledema, especially if bilateral.*
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*Axial DWI in the same patient demonstrates subtle high signal <img src='img/arrows/CS.png'/> in the region of the optic nerve heads bilaterally. Hyperintensity of the optic nerve heads on DWI can serve as a useful imaging marker for papilledema, especially if bilateral.*
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*Axial T1 C+ MR in the same patient shows subtle enhancement <img src='/img/arrows/CC.png'/>, as well as protrusion of prelaminar optic nerves bilaterally.*
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*Axial T1 C+ MR in the same patient shows subtle enhancement <img src='img/arrows/CC.png'/>, as well as protrusion of prelaminar optic nerves bilaterally.*
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*Coronal T2 FS MR in the same patient shows a partially empty sella <img src='/img/arrows/CC.png'/> with the pituitary gland <img src='/img/arrows/CS.png'/> flattened along the floor of the sella. Idiopathic intracranial hypertension is more commonly observed in overweight women of reproductive age. Treatment includes weight loss and medications, as well as lumbar punctures, shunt, and optic nerve fenestration.*
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*Coronal T2 FS MR in the same patient shows a partially empty sella <img src='img/arrows/CC.png'/> with the pituitary gland <img src='img/arrows/CS.png'/> flattened along the floor of the sella. Idiopathic intracranial hypertension is more commonly observed in overweight women of reproductive age. Treatment includes weight loss and medications, as well as lumbar punctures, shunt, and optic nerve fenestration.*
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*Coronal T2 FS MR of orbits in a 6 year old with papilledema and opening CSF pressure of 32 cm of H₂O shows dilated optic nerve sheaths bilaterally <img src='/img/arrows/CC.png'/>.*
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*Coronal T2 FS MR of orbits in a 6 year old with papilledema and opening CSF pressure of 32 cm of H₂O shows dilated optic nerve sheaths bilaterally <img src='img/arrows/CC.png'/>.*
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*Sagittal T2 FS MR in the same patient shows tortuosity of the optic nerve, dilated optic nerve sheath <img src='/img/arrows/WS.png'/>, flattening of the posterior sclera <img src='/img/arrows/CC.png'/>, and mild bulging of the optic nerve disc head <img src='/img/arrows/CS.png'/> due to papilledema. Findings are typical of idiopathic intracranial hypertension (IIH). Childhood obesity has a strong association with ↑ risk of pediatric IIH.*
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*Sagittal T2 FS MR in the same patient shows tortuosity of the optic nerve, dilated optic nerve sheath <img src='img/arrows/WS.png'/>, flattening of the posterior sclera <img src='img/arrows/CC.png'/>, and mild bulging of the optic nerve disc head <img src='img/arrows/CS.png'/> due to papilledema. Findings are typical of idiopathic intracranial hypertension (IIH). Childhood obesity has a strong association with ↑ risk of pediatric IIH.*
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*Sagittal T2 MR in a young female with IIH and temporal lobe epilepsy shows a defect <img src='/img/arrows/CS.png'/> along the floor of the middle cranial fossa with herniation of the anteroinferior temporal lobe <img src='/img/arrows/CC.png'/>.*
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*Sagittal T2 MR in a young female with IIH and temporal lobe epilepsy shows a defect <img src='img/arrows/CS.png'/> along the floor of the middle cranial fossa with herniation of the anteroinferior temporal lobe <img src='img/arrows/CC.png'/>.*
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*Coronal CT cisternogram in a patient with IIH shows an osteodural defect <img src='/img/arrows/CC.png'/> along the great wing of the sphenoid. Defect along the lateral wall of the sphenoid sinus <img src='/img/arrows/CS.png'/> with a meningocele and contrast <img src='/img/arrows/CO.png'/> in the lateral sphenoid sinus due to CSF leak is shown. Patients with IIH can present with spontaneous CSF leaks.*
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*Coronal CT cisternogram in a patient with IIH shows an osteodural defect <img src='img/arrows/CC.png'/> along the great wing of the sphenoid. Defect along the lateral wall of the sphenoid sinus <img src='img/arrows/CS.png'/> with a meningocele and contrast <img src='img/arrows/CO.png'/> in the lateral sphenoid sinus due to CSF leak is shown. Patients with IIH can present with spontaneous CSF leaks.*
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*MIP image of a postcontrast MR venogram study in a patient with IIH shows stenosis of the distal transverse sinuses bilaterally <img src='/img/arrows/CS.png'/>, right > left.*
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*MIP image of a postcontrast MR venogram study in a patient with IIH shows stenosis of the distal transverse sinuses bilaterally <img src='img/arrows/CS.png'/>, right > left.*
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*3D VRT MR in the same patient shows transverse sinus stenosis <img src='/img/arrows/CC.png'/>, right > left. Phase contrast and postcontrast MR venogram techniques are preferred over TOF-MR venogram to evaluate for transverse sinus stenosis. Stenting of transverse sinus stenosis in patients with IIH is a controversial treatment option.*
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*3D VRT MR in the same patient shows transverse sinus stenosis <img src='img/arrows/CC.png'/>, right > left. Phase contrast and postcontrast MR venogram techniques are preferred over TOF-MR venogram to evaluate for transverse sinus stenosis. Stenting of transverse sinus stenosis in patients with IIH is a controversial treatment option.*
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### Additional Images
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*Coronal T1WI MR in the same patient shows unusually small lateral ventricles with a "pinched" appearance. These findings in an obese female with headaches and papilledema are consistent with IIH.*
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*Axial T2WI MR shows ↑ fluid in bilateral optic nerve sheaths with mild flattening of the globes at optic nerve insertion. Also note the CSF-filled and expanded empty sella <img src='/img/arrows/BS.png'/>.*
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*Axial T2WI MR shows ↑ fluid in bilateral optic nerve sheaths with mild flattening of the globes at optic nerve insertion. Also note the CSF-filled and expanded empty sella <img src='img/arrows/BS.png'/>.*
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*Sagittal T1WI MR in another patient with IIH ("pseudotumor cerebri") shows empty sella <img src='/img/arrows/BC.png'/>. The ventricular size is normal.*
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*Sagittal T1WI MR in another patient with IIH ("pseudotumor cerebri") shows empty sella <img src='img/arrows/BC.png'/>. The ventricular size is normal.*
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*Axial T2WI MR shows ↑ fluid in the sheaths surrounding the optic nerves <img src='/img/arrows/WC.png'/>, associated with severe scleral flattening <img src='/img/arrows/BO.png'/>.*
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*Axial T2WI MR shows ↑ fluid in the sheaths surrounding the optic nerves <img src='img/arrows/WC.png'/>, associated with severe scleral flattening <img src='img/arrows/BO.png'/>.*
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*Axial T2WI MR shows dilated CSF spaces around the optic nerves <img src='/img/arrows/WO.png'/> and protrusion of the optic nerve papilla into the posterior globes <img src='/img/arrows/WC.png'/>. Opening CSF pressure in this 32-year-old woman was 45 cm of H₂O. Prominent CSF space in the suprasellar cistern represents an empty sella <img src='/img/arrows/WS.png'/>. Note the tortuosity of the left optic nerve.*
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*Axial T2WI MR shows dilated CSF spaces around the optic nerves <img src='img/arrows/WO.png'/> and protrusion of the optic nerve papilla into the posterior globes <img src='img/arrows/WC.png'/>. Opening CSF pressure in this 32-year-old woman was 45 cm of H₂O. Prominent CSF space in the suprasellar cistern represents an empty sella <img src='img/arrows/WS.png'/>. Note the tortuosity of the left optic nerve.*
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*Sagittal T1WI MR in the same patient shows a partially empty sella <img src='/img/arrows/WS.png'/>, suggesting high CSF pressure in this young obese woman with headaches.*
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*Sagittal T1WI MR in the same patient shows a partially empty sella <img src='img/arrows/WS.png'/>, suggesting high CSF pressure in this young obese woman with headaches.*
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*Axial T1WI C+ MR in the same patient demonstrates enhancement, as well as protrusion of prelaminar optic nerves bilaterally <img src='/img/arrows/WC.png'/>. Mild diffuse optic nerve sheath enhancement is also present.*
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*Axial T1WI C+ MR in the same patient demonstrates enhancement, as well as protrusion of prelaminar optic nerves bilaterally <img src='img/arrows/WC.png'/>. Mild diffuse optic nerve sheath enhancement is also present.*
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*Coronal T1WI C+ FS MR in the same patient shows diffuse enhancement of the optic nerve sheaths <img src='/img/arrows/WC.png'/> associated with prominent subarachnoid spaces along the optic nerves. Treatment for pseudotumor cerebri includes weight loss and medications, as well as lumbar punctures, shunt, and optic nerve fenestration.*
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*Coronal T1WI C+ FS MR in the same patient shows diffuse enhancement of the optic nerve sheaths <img src='img/arrows/WC.png'/> associated with prominent subarachnoid spaces along the optic nerves. Treatment for pseudotumor cerebri includes weight loss and medications, as well as lumbar punctures, shunt, and optic nerve fenestration.*
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*Sagittal T1 MR in a patient with IIH shows a partially empty sella <img src='/img/arrows/CC.png'/> with the pituitary gland <img src='/img/arrows/CS.png'/> flattened along the floor of the sella.*
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*Sagittal T1 MR in a patient with IIH shows a partially empty sella <img src='img/arrows/CC.png'/> with the pituitary gland <img src='img/arrows/CS.png'/> flattened along the floor of the sella.*
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*MIP image of a postcontrast MR venogram study in the same patient shows stenosis of the distal transverse sinuses bilaterally <img src='/img/arrows/CS.png'/>. Transverse sinus stenosis is common in patients with IIH.*
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*MIP image of a postcontrast MR venogram study in the same patient shows stenosis of the distal transverse sinuses bilaterally <img src='img/arrows/CS.png'/>. Transverse sinus stenosis is common in patients with IIH.*
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*Axial T2WI MR in a young obese female with headaches and visual symptoms shows mild dilatation of the CSF spaces <img src='/img/arrows/CS.png'/> around the optic nerves. There is mild flattening of the posterior sclera <img src='/img/arrows/CC.png'/> and minimal protrusion of the optic nerve papilla <img src='/img/arrows/CO.png'/> into the posterior globe.*
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*Axial T2WI MR in a young obese female with headaches and visual symptoms shows mild dilatation of the CSF spaces <img src='img/arrows/CS.png'/> around the optic nerves. There is mild flattening of the posterior sclera <img src='img/arrows/CC.png'/> and minimal protrusion of the optic nerve papilla <img src='img/arrows/CO.png'/> into the posterior globe.*
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*3D TOF-MR venogram image in the same patient shows stenosis in the distal transverse sinuses bilaterally <img src='/img/arrows/CC.png'/>. Stent placement in sinus stenosis with significant pressure differentials has shown to reduce papilledema.*
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*3D TOF-MR venogram image in the same patient shows stenosis in the distal transverse sinuses bilaterally <img src='img/arrows/CC.png'/>. Stent placement in sinus stenosis with significant pressure differentials has shown to reduce papilledema.*
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