Efficacy of Unilateral Stenting in Idiopathic Intracranial Hypertension with Bilateral Venous Sinus Stenosis: A Case Report

摘要

As the pathogenesis of idiopathic intracranial hypertension (IIH) remains elusive, different medical and surgical treatments merit consideration.A 60-year-old woman was admitted for headaches and reduced visual acuity (6/10 right, 5/10 left). She presented bilaterally increased papilla volumes and bilateral deficits in the inferior quadrant. Brain MRI showed fluid accumulation in the optic nerve sheaths, reduced ventricle size and a normal sella. CSF pressure was 30 cm of water. The diagnosis of IIH was made. The removal of 40 ml of CSF failed to alleviate symptoms. Acetazolamide treatment was initiated but, as a result of major side effects, was terminated prematurely by the patient. Subsequently, she refused further medical treatment. Symptoms worsened and the patient was readmitted. CSF pressure was 38 cm of water. A brain venous angiogram was performed, revealing bilateral stenosis of the transverse sinuses. The lead catheter could not pass through the stenosis on the left side. On the right side, the absolute venous pressure was 33 mm above and 18 mm below, and a stent was inserted by endovascular technique (fig. 1). The patient was heparinizedduring the procedure, followed by long-term therapy with clopidogrel. Clinical improvement was immediate, marked by alleviation of headaches, regression of the papillary edema, and a return to normal visual acuity (10/10 right, 9/10 left). In this case angioplastic intervention proved efficacious, and no other surgical or medical treatment was performed.