Reversible transverse sinus collapse in a patient with idiopathic intracranial hypertension

Abstract

SUMMARYThe association of idiopathic intracranial hypertension (IIH) with stenosis or narrowing of the transverse sinuses (TSs) is well known. However, there is debate as to whether the stenosis is a cause or consequence. Here we describe a case of IIH and narrowing of the TSs, with four relapses and recoveries after repeated CSF diversions with lumbar puncture (LP) over 2 months. Subsequently, implantation of a lumboperitoneal shunt (LPrS) ensured recovery. MR venography 20 months after LPrS showed normally calibrated TSs. We show repeated MR venography findings before and after the LPs, and discuss the pathogenesis of IIH in terms of the cause and effect relationship between IIH and sinus collapse. BACKGROUND

Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

“…The relationships between TSS and IIH on the one hand and TSS and SSWA on the other, although repeatedly confirmed, are still poorly understood. For IIH, there are conflicting data, some that support TSS as a cause of IIH and others that suggest TSS results from IIH . For SSWAs, it is more likely, although still unconfirmed, that TSS causes flow anomalies that directly result in the formation of a diverticulum or dehiscence .…”

“…For IIH, there are conflicting data, some that support TSS as a cause of IIH and others that suggest TSS results from IIH. [15][16][17] For SSWAs, it is more likely, although still unconfirmed, that TSS causes flow anomalies that directly result in the formation of a diverticulum or dehiscence. 9 The present data, which demonstrate that the majority of stenoses associated with SSWA are limited to or include the distal transverse sinus immediately proximal to the starting point of most SSWAs, support this hypothesis.…”

Venous sinus stenting in patients without idiopathic intracranial hypertension

“…This hypothesis is supported by evidence of elevated dural venous sinus pressures in patients with hydrocephalus and venous sinus stenosis, as well as the near-immediate resolution of elevated ICP after dural venous sinus stent placement 19 20. Conversely, reduction in ICP can alleviate some cases of venous sinus stenosis,21 22 though others have not found such a relationship 23…”

Predictors for venous sinus stent retreatment in patients with idiopathic intracranial hypertension

“…Both types have been included in the series described by Ahmed et al ,16 with reportedly good results. Unsurprisingly, relief of elevated ICP by CSF diversion results in reduction in transverse sinus narrowing in some of these patients 27 28…”