Neurology India, Vol. 59, No. 3, May-June, 2011, pp. 493-494
A Sen, C Kesavdas
Imaging Sciences and Interventional Radiology, SCTIMST, Thiruvananthapuram, Kerala, India
Correspondence Address: C Kesavdas Imaging Sciences and Interventional Radiology, SCTIMST, Thiruvananthapuram, Kerala India firstname.lastname@example.org
Date of Submission: 01-May-2011
Code Number: ni11154
We agree with Dr. Saifudheen comments,  that fluctuation in intracranial pressure may have a role in the etiopathogenesis of intermittent cerebral herniation and CSF rhinorrhea; in fact, we have concluded our letter  saying that its role should be studied. However, our patient had no definite features of idiopathic intracranial hypertension (IIH). There was no clinical suspicion of intracranial hypertension or evidence of papilledema. Other than an empty sella and a mildly prominent perioptic nerve sheath fluid, none of the other classical radiological signs ,, of intracranial hypertension (such as vertical buckling of optic nerve and flattening of the posterior sclera) were present.
Noting the finding of an empty sella we had raised the possibility of intracranial hypertension and had suggested CSF pressure recording to our referring clinicians for completion of workup. Since the patient had become asymptomatic after the lumbar puncture done to rule out meningitis, the clinicians were reluctant to repeat the procedure for a pressure recording. The possibility that CSF pressure could be low during the asymptomatic period was also considered. The patient has been discharged. The referring clinicians have agreed to do a CSF pressure recording if the patient presents again with headache or CSF rhinorrhea.
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