Case of the Week

Coronal STIR image (A) shows distended optic nerve sheaths (arrows). MR venography (B) shows bilateral stenosis of the transverse-sigmoid junction (arrows). Sagittal T1WI (C) shows mild flattening of the pituitary gland (arrow). Twenty days after discontinuation of ATRA, lumbar puncture, and acetazolamide therapy, there is normalization of perioptic CSF spaces (D) and the appearance of subdural effusions (arrowheads) with resolution of dural venous sinus stenosis (E). Postcontrast T1WI shows neuroradiologic signs of intracranial hypotension (F), including pachymeningeal enhancement (arrowheads), an enlarged pituitary gland (asterisk), and acquired tonsillar ectopia (arrows).