Reversible giant arachnoid granulations
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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
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
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