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The cause of idiopathic intracranial hypertension (IIH) remains unknown but catheter venography has shown that many patients have intracranial venous hypertension proximal to transverse sinus stenoses. These stenoses have subsequently been demonstrated on magnetic resonance and CT venography and it has been proposed that by reducing the passive resorption of CSF, intracranial venous hypertension due to these stenoses might be the cause of IIH. However, CSF withdrawal reduces venous sinus pressures, implying that venous hypertension is a secondary phenomenon.1 Moreover, resolution of transverse sinus stenoses has been reported in three patients with IIH treated by CSF diversion procedures.2,3 We report a patient with IIH in whom catheter and CT venography showed transverse sinus stenoses which resolved immediately after CSF withdrawal by lumbar puncture (LP).
A 35 year old woman presented with a 2 year history of headache and transient visual obscurations. She had papilloedema and constricted visual fields but no focal neurology. MRI of the brain was normal. At LP, the opening pressure was 35 cm H2O with normal CSF constituents. IIH was diagnosed and treatment started with acetazolamide 250 mg three times daily.
One year later the patient was referred to our institution with persistent headaches and papilloedema for consideration of a CSF diversion procedure. Magnetic resonance venography at this time suggested stenoses in the anterior part of …
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