Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) that predominantly affects young obese women. IIH is a diagnosis of exclusion. That is, if increased ICP is suspected, magnetic resonance imaging and magnetic resonance venography of the brain are recommended to exclude secondary causes. Imaging findings, such as empty sella, orbital findings, meningocele, and encephalocele, are not diagnostic of ICP, nor does their absence exclude ICP either. Therefore, venous manometry is recommended as the gold standard for evaluation, regardless of previous anatomic imaging results. Venous manometry is an invasive examination that is frequently applied to derive physiologic information concerning the nature of the pressure gradient. However, the pathogenesis of IIH has not been fully elucidated. The presence of venous sinus stenosis in a subset of patients has provided some support for the potential mechanisms underlying this condition. Hence, this review provides an up‐to‐date discussion on the potential pathogenic mechanisms of IIH with a special focus on venous sinus stenosis.Level of Evidence1Technical Efficacy Stage2

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4D flow MRI provides detailed insight into the alterations of hemodynamic，including quantitative assessment of flow parameters for the venous system. This technique overcomes the missing hemodynamic information of standard magnetic resonance imaging and the invasive disadvantage of digital subtraction angiography (DSA). Through data visualization and quantification, the particle tracking map is obtained and the peak velocities, wall shear stress (WSS) is calculated. The dynamics of venous sinus stenosis will change especially in severe area.