Presentation
Headaches and fever. The neurological examination is normal.
Patient Data
No intracranial bleeding. The ventricles are of normal size and configuration without any evidence of hydrocephalus. The midline structures are intact and unremarkable.
The bone windows demonstrate no fractures.
Mild irregularities of the cervical internal carotid arteries (segment C1) suggestive of fibromuscular dysplasia.
Focal dilatation of the right superior ophthalmic vein.
Right-sided extra-axial parafalcine non-enhancing mass, with peripheral calcifications, suggestive of meningioma.
No bone lesions.
Case Discussion
Without Valsalva manoeuvre, orbital varices may be very difficult or impossible to diagnose, as they may completely collapse, and only a focal dilatation is sometimes seen. To confirm the diagnosis, a CT with straining should be performed to demonstrate the increase in the size of the venous dilatations.
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