Re: Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis - Author Reply
Beau B.Bruce, Assistant Professor, Emory Universitybbbruce@emory.edu
Beau B. Bruce, Atlanta, GA; Nancy J. Newman, Atlanta, GA; Valerie Biousse, Atlanta, GA
Submitted February 07, 2013
We appreciate Drs. Bono and Quattrone's contributions to this area of research and thank them for highlighting their work in support of our conclusions. We have also found that bilateral transverse sinus stenosis (TSS) can occur rarely in patients with normal CSF opening pressure. [1] Concerning idiopathic intracranial hypertension (IIH), clinical management in our practice is guided by visual function and symptom severity; we usually obtain lumbar puncture only at the time of diagnosis unless there is diagnostic uncertainty or evidence of worsening. Therefore, it is likely that our results will be useful to others who practice in a similar fashion, even though we did not demonstrate normalization of the CSF opening pressure. In addition, as we reported, [2] there was a trend toward higher initial CSF opening pressure predicting both a poor clinical course and greater visual field loss, even though there was no association between TSS and CSF opening pressure and no association between TSS and clinical course. The association between CSF opening pressure and clinical course in our data reinforces the suggestion by Drs. Bono and Quattrone that CSF opening pressure should be considered in the management of patients with IIH.
1. Kelly LP, Saindane AM, Bruce BB, et al. Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure? Clin Neurol Neurosurg. 2012 Dec 5. Epub ahead of print.
2. Riggeal BD, Bruce BB, Saindane AM, et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis.
Neurology 2013;80;289.
For disclosures, please contact the editorial office at journal@neurology.org.
We appreciate Drs. Bono and Quattrone's contributions to this area of research and thank them for highlighting their work in support of our conclusions. We have also found that bilateral transverse sinus stenosis (TSS) can occur rarely in patients with normal CSF opening pressure. [1] Concerning idiopathic intracranial hypertension (IIH), clinical management in our practice is guided by visual function and symptom severity; we usually obtain lumbar puncture only at the time of diagnosis unless there is diagnostic uncertainty or evidence of worsening. Therefore, it is likely that our results will be useful to others who practice in a similar fashion, even though we did not demonstrate normalization of the CSF opening pressure. In addition, as we reported, [2] there was a trend toward higher initial CSF opening pressure predicting both a poor clinical course and greater visual field loss, even though there was no association between TSS and CSF opening pressure and no association between TSS and clinical course. The association between CSF opening pressure and clinical course in our data reinforces the suggestion by Drs. Bono and Quattrone that CSF opening pressure should be considered in the management of patients with IIH.
1. Kelly LP, Saindane AM, Bruce BB, et al. Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure? Clin Neurol Neurosurg. 2012 Dec 5. Epub ahead of print.
2. Riggeal BD, Bruce BB, Saindane AM, et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 2013;80;289.
For disclosures, please contact the editorial office at journal@neurology.org.