Unilateral expanding petrous apex cephalocele and contralateral vitreous hemorrhage in a young patient with intracranial hypertension

PURPOSE: To report a case of unilateral petrous apex cephalocele (PAC) and contralateral vitreous hemorrhage in a young patient with intracranial hypertension. OBSERVATIONS: A 12-year-old boy had acute visual loss in the right eye. The clinical and radiological findings were consistent with right vitreous hemorrhage with mild intracranial hypertension and left PAC. Cerebral angiography demonstrated low flow of the left inferior petrosal sinus and anterior venous high flow from the cavernous sinus to the facial vein via the superior ophthalmic vein. The presence of an expanding PAC, blocking the venous flow away from the inferior petrosal sinus, would produce an ipsilateral intraocular pressure (IOP) (20 mmHg) mildly higher than the other one (16 mmHg) although it is in the normal range, which may have caused the difference of the translaminar pressure gradient resulting from the balance between the cerebrospinal flow pressure and the IOP. CONCLUSION AND IMPORTANCE: Unilateral expanding PAC may cause intracranial hypertension with different severity of papilledema between two eyes.