Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT Scans

Abstract

SUMMARY -Idiopathic intracranial hypertension (IIH) is a clinical disorder of unknown etiology. It may exhibit several non-specific imaging findings. We observed that patients with intracranial hypertension demonstrate intracranial venous sinus attenuation with changes in the contour and caliber of the distal transverse sinus. This can be seen on routine non-contrast sagittal reformatted CT images of the brain. We have termed this the venous attenuation sign (VAS). This study evaluated the VAS as a marker for IIH assessing the transverse sinuses on sagittal reformatted non-contrast CT for the presence of a VAS in 25 patients with IIH and 24 control patients. Scans were independently assessed in a blinded fashion by three readers. The readers identified the VAS

Empty Sella and Sagittal Sinus Thrombosis in a Woman with Subaortic Stenosise

“…The panel of blood routine determinations related to prothrombotic disorders revealed unremarkable results. Therefore, idiopathic CVST with obstruction of the sagittal sinus was considered the most probable diagnosis; hypothesis that is in accordance with the literature about this condition affecting obese young females [3,5,[7][8][9][10]12]. Worthy of note were the psychiatric manifestations that might be associated with the empty sella syndrome [6].…”

“…She utilized oral anticoagulant during four years and stopped in the last two months; used paroxetine, valproic acid and quetiapine for one year; and was in regular use of AAS (100 mg daily) and sertraline (50 mg daily) for three months. [4,5,10]. Both types of IH should be investigated by neuroimaging studies including MR and MR/CT venography, because sinus venous occlusions can be the etiology of isolated intracranial hypertension in more than 30% of cases [4,10].…”

“…Secondary IH (SIH) may be due to tumor, infection, obstruction of CSF flow, and arteriovenous fistula [1][2][3][6][7][8][9][10]. CVT cab be confirmed by images of triangle and empty delta signs, and loss of flow void [1,10,11]. CVTs are less common than arterial thromboses, but under diagnosis occur without imaging evaluations; arterial stroke and other benign and malignant disorders are differential diagnosis [1][2][3].…”

“…The sella turcica may be partially or totally filled with cerebrospinal fluid and the hypophysis is compressed; in cases of shrinking or flattening of the gland, Magnetic Resonance (MR) study can show the sella appearing totally or partially empty -the empty sella syndrome [3,4,[6][7][8][9][10][11][12][13]. This condition may be related to SIH or Idiopathic IH (IIH), but the gland volume has no correlation with Intracranial Pressure (ICP) [3,4,9].…”

“…This condition may be related to SIH or Idiopathic IH (IIH), but the gland volume has no correlation with Intracranial Pressure (ICP) [3,4,9]. IIH (or pseudotumor cerebri), affects up to 35% of population, mainly middle aged obese and hypertensive women (5:1 compared to men) [3][4][5][6][7][8][9][10]12]. Obesity is one major risk factor of IIH, and has growing prevalence in Western countries; with visual involvement in up to 90% of cases, causing severe deficits in up to 24% of them [12].…”