Lateral sinus stenoses in idiopathic intracranial hypertension resolving after CSF diversion

Abstract

There is debate about the role of venous outflow obstruction in the etiology of idiopathic intracranial hypertension (IIH). Patients with IIH frequently have high pressures in the superior sagittal sinus proximal to stenotic lesions in the lateral sinuses that could be the cause of raised intracranial pressure.1,2⇓ Contrary to this, it has been shown that reducing intracranial pressure by withdrawing CSF reduces intrasinus pressures, implying that the stenoses are a secondary phenomenon.3 Meanwhile IIH has been treated successfully by stenting the lateral sinuses.4,5⇓ So the issue is unresolved. Does stenting simply mitigate an effect of raised intracranial pressure on venous outflow or does it address the cause of raised intracranial pressure itself? With reference to this question, we describe a patient with IIH in whom stenotic lesions in the lateral sinuses resolved following insertion of a lumboperitoneal shunt. A 29-year-old woman, body mass index 34 kg/m2, presented with a 12-month history of increasing headache. She had a past history of deep vein thrombosis and four miscarriages. Examination …