Jump to content

Confusing case with conflicting results


Recommended Posts

Hey, I have someone I can't figure out. Two docs I work with also are completely confused. I have a young woman, late teens, who is morbidly obese. Was referred by ophthalmology for bilateral "marked" papilledema. When I saw her, she had pretty classic symptoms for idiopathic intracranial hypertension with the addition of neck pain that seemed mechanical in nature. MRI/MRV showed various minor abnormalities all consistent with IIH, along with 8 mm Chiari malformation. I ordered an MRI C-spine, which is currently pending. So far everything is fitting and falling into place. 

 

We got a lumbar puncture and the opening pressure was only 5 cm H2O. I called the PA who performed it to make sure there wasn't a typo in the report, but sure enough it was only 5. She said they almost had to aspirate spinal fluid, when they were obviously expecting it to gush out. 

 

Any thoughts as to what's going on? She wasn't on any medication that would transiently cause increased intracranial hypertension. No other comorbidities. Exam is unremarkable. The only thing we were thinking was that the ophthalmologist overcalled the papilledema, but why would the MRI/MRV show so many abnormalities consistent with IIH (narrowing transverse sinuses, minimal enhancement optic nerves, partially empty sella)?

 

How would someone have signs of intracranial hypERtension on MRI/MRV but then hypOtension on lumbar puncture??

Link to comment
Share on other sites

Actually, my nurse just talked to her and she did have improvement of her vision problems and tinnitus after the tap, got worse again last night (a little over 24 hr after the tap). She's getting MRI c-spine today to look for syringomyelia, ordered it with contrast as well. That was the only thing I could think of as a possibility for the opening pressure being so low, but the completely normal exam (other than papilledema) was throwing me off, no other signs or symptoms of myelopathy. We'll see what the scan shows!

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More