a-c T2-weighted sequences from the initial MRI of the brain, performed during investigation of the headache and nausea, demonstrate findings consistent with IIH. a Transverse T2-weighted image shows significant distention of the perioptic nerve sheaths with flattening of the posterior sclera of both globes; b sagittal T2-weighted image showing same findings and in addition vertical tortuosity of the intraorbital optic nerve; c sagittal T2-weighted image with mild reduction in the height of the hypophysis. d-g MRI sequences obtained at the time of rapid deterioration with impairment of vision and encephalopathy. d Transverse FLAIR image demonstrates multiple bilateral subcortical hyperintense lesions dominating in the parietal and occipital lobes; e transverse T1

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... episode. Medical advice was sought at the local county hospital after 3 weeks of increasing symptoms with headache and nausea. Routine blood sampling and neurologic and ophthalmologic examinations were normal. Magnetic resonance imaging revealed optic nerve sheath distension and a minor bilateral intraocular protrusion of the optic nerves (Fig. 1a-c gadolinium (Gd) image shows incomplete ring or nodular contrast enhancement in some of the subcortical lesions; f coronal FLAIR image shows bilateral optic nerve head protrusion into the globes; g sagittal T1 Gd image showing protrusion of the optic nerve head into the globes and diffuse contrast enhancement in both optic nerves. h-i: ...

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... VP shunt placement and steroid treatment. h T2 transverse image shows regress of distention of perioptic nerve sheaths, posterior globe flattening, and optic nerve head protrusion into the globe; i FLAIR transverse image shows complete regression of the intracerebral signal changes An acute MRI revealed extensive signs of neuroinflammation ( Fig. 1d−g). A new diagnostic work-up was performed (Table 1), and a diagnosis of ADEM with bilateral optic neuritis (ON) causing high ICP and visual loss was made. Due to the severe situation with an eminent threat of losing visual function, he received a VP shunt within hours from arrival to the pediatric intensive care unit. An ICP sensor ...

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... clinical and neuroradiological follow-ups (Fig. 1h- i) have been uneventful with the exception of a few episodes with recurrent headache. At 1-year follow-up, there was full recovery with normal visual function and without any neurologic deficits. Multiple ICP measurements with the Miethke sensor system were within normal range, both at episodes with recurrent headache and at 1-year ...