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December 11, 2018; 91 (24) NeuroImages

Reversible giant arachnoid granulations

Guillaume Taieb, Cyril Dargazanli, Pauline Prin, Mahmoud Charif, Anne Ducros
First published December 10, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006656
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A 16-year-old boy with recurrent transient visual loss had bilateral papilledema. MRI revealed giant arachnoid granulations (GAG) in both transverse sinuses and signs of intracranial hypertension (figure). CSF opening pressure was 420 mm H2O. After depletive lumbar puncture, the size of GAG decreased and sinus lumen stenosis resolved (figure). Arachnoid granulations (AG) are CSF herniations through dural defects into sinuses.1 Since CSF removal led to their regression, GAG might be a consequence of intracranial hypertension. Our case supports the Krisch theory, which considers AG as a buffer of CSF compartment rather than a site of CSF absorption.2

Figure
Figure CSF and blood compartment changes after depletive lumbar puncture

Axial T2-weighted image shows optic nerve tortuosities (arrowheads, A). Axial (B) and frontal (C) postcontrast T1-weighted imaging and magnetic resonance venography (D) reveal giant arachnoid granulations (GAG) (asterisks) and sinus lumen stenosis (arrows, B). Five days after lumbar puncture, optic nerve tortuosities (arrowheads, E), GAG (arrows, F–H), and sinus lumen stenosis (arrowheads, F) disappeared.

Author contributions

G. Taieb: analysis and interpretation of data, drafting, critical revision of manuscript for intellectual content. C. Dargazanli: drafting and revision of manuscript, acquisition of data. P. Prin: acquisition of data, critical revision of manuscript for intellectual content. M. Charif: critical revision of manuscript for intellectual content. A. Ducros: analysis and interpretation of data, drafting, critical revision of manuscript for intellectual content.

Study funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

References

  1. 1.↵
    1. le Gros Clark WE
    . On the pacchionian bodies. J Anat 1920;55:40–48.
    OpenUrlPubMed
  2. 2.↵
    1. Krisch B
    . Ultrastructure of the meninges at the site of penetration of veins through the dura mater, with particular reference to pacchionian granulations. Investigations in the rat and two species of New-World monkeys (Cebus apella, Callitrix jacchus). Cell Tissue Res 1988;251:621–631.
    OpenUrlCrossRefPubMed
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