Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

Neurology recent issues

Riggeal et al.¹ found no correlation between the degree of transverse sinus stenosis (TSS) and the clinical course in idiopathic intracranial hypertension (IIH). There is no direct evidence of normalization of the CSF pressure in this series and this demonstration is needed to support their observation. The authors did not cite our studies^2,3 that may confirm their findings. We studied 14 consecutive patients with IIH over a 6-year period. At presentation and during follow-up, patients underwent CSF pressure measurements and magnetic resonance venography. TSS persisted after normalization of the CSF pressure in 9 patients with a good clinical course, suggesting the lack of a direct relationship between the caliber of TSS and CSF pressure in IIH. Moreover, unilateral TSS was observed in 30% of 111 subjects with normal CSF pressure, whereas bilateral TSS occurred in only 1.8% of individuals.³ Our observations provide evidence that bilateral TSS is one of the factors contributing to IIH. Our findings support the observations of Riggeal et al. and suggest that both clinical course and CSF pressure should determine the management of patients with IIH in clinical practice.

Original Article: http://www.neurology.org/cgi/content/short/81/7/695?rss=1

Julio Pereira, MD

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