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. 2013 Aug;115(8):1215-9.
doi: 10.1016/j.clineuro.2012.11.004. Epub 2012 Dec 5.

Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure?

Linda P Kelly  1 , Amit M Saindane, Beau B Bruce, Maysa A Ridha, Bryan D Riggeal, Nancy J Newman, Valérie Biousse
Affiliations

Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure?

Linda P Kelly et al. Clin Neurol Neurosurg. 2013 Aug.

Abstract

Objective: Transverse cerebral venous sinus stenosis (TSS) is common among patients with idiopathic intracranial hypertension. TSS likely also exists among individuals with normal intracranial pressure (ICP) but the prevalence is unclear. The goal of this study was to identify patients with incidental TSS and normal ICP and describe their characteristics.

Methods: Among 240 adult patients who underwent brain magnetic resonance imaging (MRI) with magnetic resonance venography (MRV) with contrast at our institution between September 2009 and September 2011, 44 had isolated TSS without further substantial imaging abnormality. Medical records were reviewed for symptoms of increased ICP, papilledema, cerebrospinal fluid (CSF) constituents and opening pressure (OP), and reason for brain imaging. Of these, 37 were excluded for confirmed or possible idiopathic intracranial hypertension. Of the remainder, 5 had CSF-OP≤25 cmH2O without papilledema, and 2 did not have measured ICP, but had no papilledema or symptoms of increased ICP. Imaging was re-interpreted to assess for signs suggestive of elevated ICP and to characterize the TSS further.

Results: All patients were women (mean age: 41, mean BMI: 37.1). CSF contents were normal, but OPs were at the upper limit of normal (22-25 cmH2O). Indications for MRI/MRV included query pituitary abnormality (1), migraine (4), and anomalous-appearing optic nerves (2). All had bilateral TSS. Six had short TSS and an empty sella; 1 had long TSS and no empty sella; 1 had flattening of the posterior sclera; 2 had prominence of peri-optic nerve CSF.

Conclusion: Asymptomatic bilateral TSS exists in patients with ICP≤25 cmH2O, but is likely uncommon. CSF-OP was at the upper limit of normal in our patients, who also had other radiologic signs suggestive (but not specific) of chronically-raised ICP. Findings of bilateral TSS on imaging should prompt funduscopic examination for papilledema.

Keywords: Empty sella; Flattening of the posterior sclera; Intracranial pressure; Intracranial venous sinus anatomy; Magnetic resonance venography; Peri-optic nerve cerebrospinal fluid; Transverse cerebral venous sinus stenosis.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Magnetic resonance venography (MRV), two views, patient 4. A, Craniocaudal projection maximum intensity projection (MIP) demonstrating bilateral transverse sinus stenosis (TSS) (arrows) with a combined conduit score of 3 (2 + 1). B, Oblique lateral projection of MIP demonstrating bilateral TSS (arrows).
Figure 1
Figure 1
Magnetic resonance venography (MRV), two views, patient 4. A, Craniocaudal projection maximum intensity projection (MIP) demonstrating bilateral transverse sinus stenosis (TSS) (arrows) with a combined conduit score of 3 (2 + 1). B, Oblique lateral projection of MIP demonstrating bilateral TSS (arrows).
Figure 2
Figure 2
Magnetic resonance venography (MRV), two views, patient 7. A, Craniocaudal projection maximum intensity projection (MIP) demonstrating bilateral transverse sinus stenosis (TSS) (arrows) with a combined conduit score of 2 (1 + 1). B, Oblique lateral projection of MIP showing the right-sided TSS in profile (arrow).
Figure 2
Figure 2
Magnetic resonance venography (MRV), two views, patient 7. A, Craniocaudal projection maximum intensity projection (MIP) demonstrating bilateral transverse sinus stenosis (TSS) (arrows) with a combined conduit score of 2 (1 + 1). B, Oblique lateral projection of MIP showing the right-sided TSS in profile (arrow).
See this image and copyright information in PMC

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