PMC10357201_01
Multicolor imaging (color figure available in the electronic version) showing papilledema with hemorrhage and optical coherence tomography (OCT) showing papilledema with secondary macular edema. Written permission to publish these images was granted by the patient.
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In the following week, however, he noticed an increasingly worsening vision with bilateral central scotoma which prompted him to present at our ophthalmology department 3 weeks after the 12th injection of nusinersen where severe bilateral papilledema with hemorrhage and secondary macular edema was diagnosed (Fig. 1). Headache had already resolved 10 days after injection of nusinersen and visual acuity and papilledema were significantly improved after two months (Table 1, Fig. 1).
MRI showing classic signs of intracranial hypertension with prominent optic discs (arrows in A), sinus stenosis (asterisk in B) and flattening of pituitary gland (C). Note extensive subarachnoid cysts with local space-occupying appearance (block arrows in C and D). Written consent to publish these images was obtained from the patient.
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There were extensive, most likely congenital, bilateral arachnoid cysts with moderate space-occupying effects (Fig. 2).