Cause or Consequence

Abstract

Aim: The aims of our study were to refer to the complex relationship between idiopathic intracranial hypertension (IIHT) and cerebral sinovenous thrombosis (CSVT), and to determine the differences and commonalities between the patients with and without CSVT in their etiology, along with documenting the uncertainties in concluding on the diagnosis and treatment of these patients. Material and Methods: IIHT was diagnosed according to Dandy criteria, while CSVT was screened for by way of a cranial magnetic resonance imaging for all patients and cranial magnetic resonance venography only if the magnetic resonance imaging was nebulous or there was a family history. Results: We retrospectively evaluated a total of 26 patients (9 of whom had CSVT) diagnosed with IIHT between 2014 and 2018. A total of 9 patients with concurrent CSVT were described as suffering from vascular IIHT, while the remaining 17 were described as suffering from other IIHT. Demographic characteristics were similar in both groups (mean age: 12 vs. 11; male/female ratio: 2/7 vs. 5/12 in vascular IIHT and other IIHT, respectively). Clinical findings, cerebrospinal fluid-opening pressure values, and pathologies of etiology were also similar (vitamin D deficiency: 66% vs. 52%; vitamin B12 deficiency: 11% vs. none; iron deficiency: 22% vs. 11%; obesity: 22% vs. 23%). A mixture of acetazolamide, topiramate, anticoagulant therapy, and acetylsalicylic acid were given according to the diagnoses. Conclusion: CSVT is a common clinical entity among the causes of IIHT, and it should be taken into consideration in this patient group. However, there is a need for a common guideline for laboratory and imaging methods to understand the etiopathogenesis of childhood IIHT and determine the patients at risk.

Chronic intracranial hypertension after cerebral venous and sinus thrombosis – frequency and risk factors

“…The present data cannot help to further elucidate the differences between patients who suffer from idiopathic IH versus those who develop IH as a secondary event. Features of patients with IH originating from idiopathic cause or from CVST, including CSF opening pressure, are very similar and the two entities may only be differentiated by imaging of the intracranial venous system [ 12 , 29 , 30 ]. However, isolated raised intracranial pressure from CVST differs in management from IIH and should be classified neither as “idiopathic IH” nor as “pseudotumor cerebri” [ 18 ].…”

“…CVST can also lead to chronical intracranial hypertension (IH) as a consequence of the altered venous drainage and can affect the overall outcome and quality of life. Previous studies already addressed the relationship between cerebral venous thrombosis and intracranial hypertension [ 12 , 13 ]. The aim of our study was to estimate the risk of developing IH after CVST and to stratify underlying risk factors for this complication by analysis of a large cohort of CVST-patients with follow-up data from our institution.…”