Authors: Ziyue Xu , Xiaolin Dong , Jingting Lu , Hailong Zhao , Gang Wu , Rui Li

Abstract

Background: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure of unknown etiology, with headache and visual disturbances being the predominant symptoms. Proposed pathophysiological mechanisms include increased cerebrospinal fluid (CSF) production, impaired CSF reabsorption, hormonal influences, and elevated venous sinus pressure.

Case Presentation: A 27-year-old female with a three-month history of headache and blurred vision presented to our department. Initial contrast-enhanced MR venography (CE-MRV) showed no obvious stenosis. However, due to persistent symptoms, high-resolution MR venography (MRV-HR) was performed, revealing bilateral transverse-sigmoid sinus stenosis. Cerebral angiography confirmed severe stenosis with a trans-stenotic pressure gradient of 22.2 mmHg. The patient underwent successful venous sinus stenting, resulting in complete symptom resolution and normalization of the pressure gradient.

Conclusion: This case highlights the diagnostic value of high-resolution MRV in detecting hemodynamically significant venous sinus stenosis that may be missed by conventional CE-MRV, emphasizing the importance of advanced imaging in guiding endovascular treatment for selected IIH patients.

Keywords: Idiopathic intracranial hypertension, transverse-sigmoid sinus stenosis, venous sinus stenting, contrast-enhanced magnetic resonance venography.