A 42-year-old woman with a body mass index of 36 presented with visual obscurations and headaches. She had a visual acuity of 6/5 bilaterally, a constricted right visual field and bilateral papilloedema. Idiopathic intracranial hypertension (IIH) was suspected but brain magnetic resonance imaging and venography demonstrated multiple enhancing lesions in the meninges with compression of the superior sagittal sinus and both transverse sinuses. The opening pressure at lumbar puncture was 26 cm CSF. Her symptoms and visual field constriction worsened despite treatment with acetazolamide and topiramate. On cerebral venography, 15–20 mm Hg pressure gradients were found across the transverse sinus stenoses and a 3 mm Hg gradient at the outflow of the superior sagittal sinus. Stenting of the three stenoses was carried out. At follow-up, her headaches and visual fields had improved and the papilloedema had resolved. This case indicates that it is vital to rule out other causes of raised intracranial pressure in patients suspected of having IIH. Cerebral venous outflow obstruction due to extrinsic compression can be treated with venous sinus stenting. Extrinsic compression of cerebral venous drainage has been proposed to be a contributing factor in IIH. Venous sinus stenting is emerging as a treatment option in IIH.
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