Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension

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Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient’s TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

ABBREVIATIONS BMI = body mass index; HVLP = high-volume lumbar puncture; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; IVUS = intravascular ultrasonography; MVP = mean venous pressure; SS = sigmoid sinus; TS = transverse sinus.
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Contributor Notes

Correspondence Thomas J. Buell, Department of Neurosurgery, University of Virginia Health System, Box 800212, Charlottesville, VA 22908. email: tjb4p@hscmail.mcc.virginia.edu.INCLUDE WHEN CITING Published online August 25, 2017; DOI: 10.3171/2017.3.JNS163181.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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