Choroidal folds associated with increased intracranial pressure

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

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.

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.

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.