Occult cerebral vascular causes of pseudotumor cerebri

Purpose: To underscore the deficiencies of standard computed imaging studies for detecting occult cerebral vascular conditions that can cause pseudotumor cerebri. Methods: Two females with normal, unenhanced computed tomography (CT) scans of the brain were initially thought to have pseudotumor cerebri. Both patients experienced a progressive clinical course. Further imaging revealed a torcular meningioma in case one, that was documented on enhanced magnetic resonance (MR) scan. The second case had a dural arteriovenous malformation identified on cerebral angiography. Conclusion: A normal noncontrast CT scan is insufficient to rule out partial obstruction of the dural sinuses by a meningioma or dural arteriovenous malformations that may increase the pressure within the dural sinuses. Thus, contrast CT or MR imaging and in some cases cerebral arteriography may be required in cases that manifest atypical clinical features.