Abstract Details

Title Arteriovenous Malformations as an Idiopathic Intracranial Hypertension Mimic: Lessons Learned and Clinical Implications

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-015

Objective To demonstrate an uncommon mimic of idiopathic intracranial hypertension (IIH).

Background Common precipitating factors of IIH include sudden weight change, uremia, and usage of steroids, vitamin A, and tetracycline. Secondary causes of increased intracranial pressure include infection, brain mass, and cerebral venous thrombosis. This case presents a rare arteriovenous malformation (AVM) as a rare mimic of IIH.

Design/Methods A 49-year-old female presented with 6 months of intermittent vision loss and right>left sided recurring, pulsating headaches. An 80 pound weight gain was endorsed, but denied vitamin A use. Ophthalmoscopic exam demonstrated bilateral grade 5 disc edema, retinal nerve fiber layer whitening with associated disc heme, and obstruction of multiple vessels. Visual fields and acuity were intact, although patient complained of a subjective left field cut. Lumbar puncture revealed an elevated opening pressure of 35 cm H2O; cerebrospinal fluid demonstrated 2 nucleated cells, 1 red blood cell, glucose 59 mg/dl and protein 24 mg/dL. Initial imaging showed protrusion of the right>left optic nerves and severe stenosis of the right>left transverse sinus. No brain mass, cerebral venous thrombus, or enhancement was seen. Findings were concerning for IIH. Patient was started on acetazolamide with no benefit; stenting of transverse sinus was considered.

Results Cerebral angiogram for pre-operative stent evaluation revealed a right occipital unruptured AVM in addition to the transverse sinus stenosis. A partial endovascular embolization of the AVM followed by sub-occipital craniotomy and resection of the right AVM nidus as well as right transverse stent for definitive management. Patient had significantly improved disc edema, headaches, and visual field at the 3-month follow-up.

Conclusions

Increased intracranial pressure secondary to unruptured AVMs is rare. Dedicated vascular imaging may be necessary to evaluate for AVMs or other uncommon etiologies. In suspected IIH with atypical features and refractory symptoms, there should be a low threshold to repeat imaging for secondary causes.

Authors/Disclosures
Lea Colantonio PRESENTER	Miss Colantonio has nothing to disclose.
David Fletcher	Mr. Fletcher has nothing to disclose.
Yongjia Deng	Mr. Deng has stock in Pfizer and Moderna.

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