Obstruction of cerebral venous sinus secondary to idiopathic intracranial hypertension

Stienen, A.; Weinzierl, Martin; Ludolph, A.; Tibussek, Daniel; Häusler, M

doi:10.1111/j.1468-1331.2008.02340.x

Cited by 45 publications

(20 citation statements)

References 15 publications

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“…It is controversially debated whether obstructed venous drainage is the primary mechanism or is secondary to another pathologic process. In this context, compressed venous sinuses may also be the result of external compression [20][21][22][23][24] by increased intracranial pressure. Galgano and Deshaies 25 stated that flow-related artifacts in noncontrast MR venography may be challenging to distinguish from pathologic venous sinus stenosis.…”

Section: Discussionmentioning

confidence: 99%

Volumetric Assessment of Optic Nerve Sheath and Hypophysis in Idiopathic Intracranial Hypertension

Hoffmann

Schmidt

Kunte

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Idiopathic intracranial hypertension is a headache syndrome characterized by increased CSF pressure. Compression of the hypophysis and distension of the optic nerve sheath are reliable imaging signs. The purpose of the study was to validate, in patients with idiopathic intracranial hypertension, MR imaging-based volumetric measurements of the optic nerve sheath and hypophysis as an objective observation method for more accurate diagnosis and posttreatment follow-up.

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Section: Discussionmentioning

confidence: 99%

Volumetric Assessment of Optic Nerve Sheath and Hypophysis in Idiopathic Intracranial Hypertension

Hoffmann

Schmidt

Kunte

et al. 2013

AJNR Am J Neuroradiol

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“…42 Reducing intracranial pressure in IIH through CSF removal or diversion results in a resolution of the transverse sinus stenosis, suggesting that it is a consequence of transverse sinus compression from intracranial hypertension. [12][13][14][15][16]43 In IIH, CSF pressure and superior sagittal sinus pressures are coupled: During a CSF infusion test, both CSF and superior sagittal sinus pressures rise and then, with drainage, fall together until central venous pressure is reached, reflecting a functional obstruction of the transverse sinus likely caused by a collapse of the transverse sinus from compression by intracranial hypertension. 44 However transverse sinus stenosis can persist in IIH after normalization of CSF pressure.…”

Section: Discussionmentioning

confidence: 99%

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

Ahmed

Wilkinson²,

Parker³

et al. 2011

AJNR Am J Neuroradiol

351

320

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BACKGROUND AND PURPOSE:Transverse sinus stenosis is common in patients with IIH. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies suggest that stent placement within a transverse sinus stenosis with a significant pressure gradient should decrease cerebral venous pressure, improve CSF resorption in the venous system, and thereby reduce intracranial (CSF) pressure, improving the symptoms of IIH and reducing papilledema. We aimed to determine if IIH could be reliably treated by stent placement in transverse sinus stenosis.

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“…Others have proposed that the distal portion of the transverse venous sinuses can become narrowed by external compression from increased intracranial pressure, a hypothesis supported by resolution of some of these stenoses following lumbar or cervical puncture or CSF shunt placement. 30 Such external compression of the sinuses likely leads to a positive feedback loop of increased venous pressure leading to impaired CSF absorption, leading to further increases in intracranial pressure, which further compresses the venous sinuses until an equilibrium is established.…”

Section: Pathophysiologymentioning

confidence: 99%

Update on Idiopathic Intracranial Hypertension

Bruce

Biousse

Newman

2011

American Journal of Ophthalmology

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Purpose Provide an update on various features of idiopathic intracranial hypertension. Design Perspective. Methods Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors’ clinical and research experience. Results Idiopathic intracranial hypertension is primarily a disease of obese women of childbearing age, but it can affect patients of any weight, sex, and age. Although a relatively rare disorder, idiopathic intracranial hypertension’s associated costs in the U.S. entail hundreds of millions of dollars. Even following treatment, headaches are frequently persistent and may require the continued involvement of a neurologist. Quality of life reductions and depression are common among idiopathic intracranial hypertension patients. However, visual dysfunction, especially visual field abnormalities, represents the major morbidity of this disorder, and serial automated perimetry remains the primary mode of patient monitoring. Patients who are men, black, very obese, or anemic are at higher risk of visual loss. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding idiopathic intracranial hypertension’s pathophysiology. Treatment studies show that lumbar puncture is a valuable treatment (in addition to its crucial diagnostic role) and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, CSF diversion procedures, and cerebral venous stenting. Conclusions Many questions remain unanswered about idiopathic intracranial hypertension. Ongoing studies, especially an ongoing NIH-funded clinical trial of acetazolamide, should provide more insight into this important, yet poorly understood syndrome of isolated intracranial hypertension.

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Obstruction of cerebral venous sinus secondary to idiopathic intracranial hypertension

Abstract: Our data demonstrate that cerebral venous sinus obstruction is frequent and frequently transient in pediatric IIH and suggest that stenoses may result from elevated intracranial pressure.

Cited by 45 publications

References 15 publications

Volumetric Assessment of Optic Nerve Sheath and Hypophysis in Idiopathic Intracranial Hypertension

Volumetric Assessment of Optic Nerve Sheath and Hypophysis in Idiopathic Intracranial Hypertension

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

Update on Idiopathic Intracranial Hypertension

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