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
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.
- © 2018 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.