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MR Imaging of Papilledema and Visual Pathways: Effects of Increased Intracranial Pressure and Pathophysiologic Mechanisms

N. Passi, A.J. Degnan and L.M. Levy
American Journal of Neuroradiology May 2013, 34 (5) 919-924; DOI: https://doi.org/10.3174/ajnr.A3022
N. Passi
aFrom the Department of Radiology, George Washington University Hospital, Washington, DC.
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A.J. Degnan
aFrom the Department of Radiology, George Washington University Hospital, Washington, DC.
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L.M. Levy
aFrom the Department of Radiology, George Washington University Hospital, Washington, DC.
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    Fig 1.

    ONS enlargement. A, Coronal T2-weighted FSE image demonstrates bilateral widening of the ONS in a 32-year-old woman who presented with acute vision loss and headaches and was found to have papilledema on fundoscopic examination. The ONSs are abnormally increased in size (TR, 6816.7 ms/TE, 84 ms; 3-mm thickness; FOV, 18 cm; matrix, 256 × 224; 4 excitations). B, Axial T2-weighted FSE image demonstrates the widening of the ONS bilaterally in a 31-year-old woman with known papilledema presenting with headaches (TR, 4400 ms/TE, 80 ms; 5-mm thickness; 6-mm spacing; FOV, 24 cm; 320 × 256 matrix).

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    Fig 2.

    Optic papilla protrusion. In this T2-weighted axial image, both ON papillae protrude into the vitreous space of the globe. This 32-year-old woman had experienced headaches and vision loss on presentation; she was also found to have papilledema on fundoscopic examination (same patient as in Fig 1A). A, Axial T2-weighted image demonstrates bilateral ON head protrusion (TR, 3000 ms/TE, 84 ms; 5-mm thickness; FOV, 24 cm; matrix, 320 × 256; 1 excitation). B, Corresponding axial T1-weighted postcontrast image demonstrates enhancement of the ON heads (TR, 766.7 ms/TE, 9 ms; 3-mm thickness; FOV, 18 cm; matrix, 320 × 191; 1 excitation).

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    Fig 3.

    Posterior globe flattening. Flattening of the posterior globe is thought to occur in the same setting as papilledema with increased ICP. In this image, the site of the optic papilla is flattened and the normal globe contour is lost. This 37-year-old woman presented with headache and a sensation of head pressure. She was found to have papilledema and increased CSF opening pressure on lumbar puncture. (TR, 5650 ms/TE, 88 ms; 5-mm thickness; FOV, 24 cm; 320 × 256 matrix).

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    Fig 4.

    ON tortuosity. Bending of the ON can be seen more prominently in the right ON in this 40-year-old woman with history of headache diagnosed with increased ICP. In this particular case, there is a smear sign, in which orbital fat obscures part of the tortuous ON (TR, 620 ms/TE, 9 ms/TI, 0 ms; 5-mm thickness; 6-mm spacing; FOV, 24 cm; 256 × 192 matrix).

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American Journal of Neuroradiology: 34 (5)
American Journal of Neuroradiology
Vol. 34, Issue 5
1 May 2013
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Cite this article
N. Passi, A.J. Degnan, L.M. Levy
MR Imaging of Papilledema and Visual Pathways: Effects of Increased Intracranial Pressure and Pathophysiologic Mechanisms
American Journal of Neuroradiology May 2013, 34 (5) 919-924; DOI: 10.3174/ajnr.A3022

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MR Imaging of Papilledema and Visual Pathways: Effects of Increased Intracranial Pressure and Pathophysiologic Mechanisms
N. Passi, A.J. Degnan, L.M. Levy
American Journal of Neuroradiology May 2013, 34 (5) 919-924; DOI: 10.3174/ajnr.A3022
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  • Article
    • Abstract
    • ABBREVIATIONS:
    • ON Anatomy
    • MR Imaging Findings
    • Pathogenesis of Papilledema
    • Using Signs of Papilledema to Diagnose Elevated ICP
    • Future Directions of MR Imaging in Papilledema Imaging
    • Conclusions
    • References
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Cited By...

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  • Automated Quantitation of the Posterior Scleral Flattening and Optic Nerve Protrusion by MRI in Idiopathic Intracranial Hypertension
  • Hyperintense Optic Nerve Heads on Diffusion-Weighted Imaging: A Potential Imaging Sign of Papilledema
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