Transcranial Doppler ultrasonography identifies symptomatic cavum septum pellucidum cyst: case report.

Authors

• Randy S Bell
• Alexander H Vo
• Michael S Dirks
• Corey Mossop
• John E Gilhooly
• Patrick B Cooper
• Alexander Y Razumovsky
• Rocco A Armonda

Publication/Presentation Date

1-1-2010

Abstract

OBJECTIVE: Cavum Septum Pellucidum (CSP) cysts are considered normal anatomic variants, comprising as many as 15% of the adult and 85% of pediatric populations. On rare occasions, the cavum can obstruct CSF outflow from the lateral ventricles causing elevated intracranial pressure (ICP) and headaches. The purpose of this paper is to present a challenging case of new onset symptomatic CSP in a previously healthy adult male without papilledema and elevated ICP detected by transcranial Doppler (TCD) ultrasonography.

CLINICAL PRESENTATION: A previously healthy 44 year-old man presented to the neurology service with debilitating positional headaches that were mitigated solely by recumbent positioning. A magnetic resonance imaging scan (MRI) of the brain revealed a cavum septum pellucidum. A lumbar puncture was performed and revealed normal ICP. No papilledema was evident on fundoscopic examination. A CSF flow study revealed normal dye opacification pattern without evidence of CSF leak.

INTERVENTION: Without other clinical indicators of high ICP, but a history suspicious for symptomatic CSP, TCD study was performed and revealed abnormally low cerebral blood flow velocities (CBFV's) and significantly elevated pulsatility indices (PI's) for patient's age indicative of high ICP. Endoscopic fenestration of the septum pellucidum was performed improving the patient's headaches and normalization of the PI's and CBFV's to normal (p< 0.01).

CONCLUSIONS: Symptomatic CSP is a difficult diagnosis to make based on existing diagnostic paradigm. TCD in the absence of other objective confirmatory studies, can aid in the diagnosis and provide information about the success of fenestration of the cavum septum.

Volume

3

Issue

1

First Page

13

Last Page

16

ISSN

1941-5893

Published In/Presented At

Bell, R. S., Vo, A. H., Dirks, M. S., Mossop, C., Gilhooly, J. E., Cooper, P. B., Razumovsky, A. Y., & Armonda, R. A. (2010). Transcranial Doppler ultrasonography identifies symptomatic cavum septum pellucidum cyst: case report. Journal of vascular and interventional neurology, 3(1), 13–16.

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

22518255

Department(s)

Administration and Leadership

Document Type

Article