Choroidal folds associated with increased intracranial pressure

Abstract

Purpose: To determine whether a relationship exists between increased intracranial pressure and the presence of idiopathic choroidal folds.

Methods: A prospective study in which 12 consecutive patients presenting with choroidal folds were evaluated by imaging studies (ultrasonography, magnetic resonance imaging, and/or computed tomography) to rule out known causes of choroidal folds, such as orbital disease, choroidal tumor, posterior scleritis, hypotony, and choroidal neovascular membrane. A lumbar puncture was performed on each of these patients, and measurement of opening pressure of cerebrospinal fluid was obtained.

Results: Twelve patients with choroidal folds included nine men and three women. Six patients (50%) presented with papilledema in the eye with choroidal folds. The other six patients (50%) presented with only choroidal folds. In this study, 10 (83%) of 12 patients had an opening pressure greater than 230 mm H(2)O. In patients presenting with only choroidal folds, five (83%) of six patients had an opening pressure greater than 230 mm H(2)O, with an average opening pressure of 290 mm H(2)O.

Conclusion: Depending on the timing of the evaluation, papilledema may or may not be present, and only choroidal folds may be seen as a reflection of increased intracranial pressure. We believe that increased intracranial pressure from any source (that is, pseudotumor cerebri, sinus thrombosis, or intracranial mass) can present with only choroidal folds; therefore, these patients should have an appropriate work-up that should probably include a lumbar puncture before the title of "idiopathic" is given to their finding.