Share

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
Full PDF
Citation
Permissions

Make Comment

See Comments

Downloads
181

Share

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
View Abstract

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top

Related Articles

  • No related articles found.

Topics Discussed

Alert Me

Advertisement