Bilateral transverse sinus stenosis is only one of the contributing factors involved in IIH
FrancescoBono, MD, Institute of Neurology, University Magna Graecia of Catanzaro, Italyf.bono@unicz.it
Francesco Bono, Catanzaro, Italy; Aldo Quattrone, Catanzaro, Italy
Submitted February 07, 2013
Riggeal et al. [1] found no correlation between the degree of transverse sinus stenosis (TSS) and the clinical course in idiopathic intracranial hypertension (IIH). Our major criticism is that there is no direct evidence of normalization of the CSF pressure in this series. We want to emphasize that the demonstration of normalization of the CSF pressure is needed to support their observation.
The authors did not cite our studies [2,3] that may confirm their findings. We studied 14 consecutive patients with IIH for over a 6-year period. At presentation and during the follow-up, patients underwent CSF pressure measurements and MR venography. TSS persisted after normalization of the CSF pressure in 9 patients who had a good clinical course, suggesting the lack of a direct relationship between the caliber of TS and CSF pressure in IIH. Moreover, unilateral TSS was observed in 30% of 111 subjects with normal CSF pressure whereas bilateral TSS occurred only in 1.8% of individuals. [3] Our observations provide evidence that bilateral TSS is only one of the contributing factors involved in IIH. Our findings support Riggeal et al.’s observation and suggest that both clinical course and CSF pressure should determine the management of patients with IIH in clinical practice.
1. Riggeal BD, Bruce BB, Saindane AM, et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis.
Neurology 2013;80;289.
2. Bono F, Giliberto C, Mastrandrea C, et al. Transverse sinus stenoses persist after normalization of the CSF pressure in IIH. Neurology 2005;
65:1090-1093.
3. Bono F, Lupo MR, Lavano A, et al. Cerebral MR venography of transverse sinuses in subjects with normal CSF pressure. Neurology 2003;61:1267-1270.
For disclosures, please contact the editorial office at journal@neurology.org.
Riggeal et al. [1] found no correlation between the degree of transverse sinus stenosis (TSS) and the clinical course in idiopathic intracranial hypertension (IIH). Our major criticism is that there is no direct evidence of normalization of the CSF pressure in this series. We want to emphasize that the demonstration of normalization of the CSF pressure is needed to support their observation. The authors did not cite our studies [2,3] that may confirm their findings. We studied 14 consecutive patients with IIH for over a 6-year period. At presentation and during the follow-up, patients underwent CSF pressure measurements and MR venography. TSS persisted after normalization of the CSF pressure in 9 patients who had a good clinical course, suggesting the lack of a direct relationship between the caliber of TS and CSF pressure in IIH. Moreover, unilateral TSS was observed in 30% of 111 subjects with normal CSF pressure whereas bilateral TSS occurred only in 1.8% of individuals. [3] Our observations provide evidence that bilateral TSS is only one of the contributing factors involved in IIH. Our findings support Riggeal et al.’s observation and suggest that both clinical course and CSF pressure should determine the management of patients with IIH in clinical practice.
1. Riggeal BD, Bruce BB, Saindane AM, et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 2013;80;289.
2. Bono F, Giliberto C, Mastrandrea C, et al. Transverse sinus stenoses persist after normalization of the CSF pressure in IIH. Neurology 2005; 65:1090-1093.
3. Bono F, Lupo MR, Lavano A, et al. Cerebral MR venography of transverse sinuses in subjects with normal CSF pressure. Neurology 2003;61:1267-1270.
For disclosures, please contact the editorial office at journal@neurology.org.