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Abstract Details

Neuro-Imaging Evidence for Reversible Collapsibility of the Distal Transverse Sinuses in Spontaneous CSF Leak
Neuro-ophthalmology/Neuro-otology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
5-004
Many patients who develop spontaneous CSF leaks have demographic similarities to IIH patients, and some patients develop symptoms of intracranial hypertension after leak repair. Spontaneous intracranial CSF leak is likely on the same spectrum disorder as idiopathic intracranial hypertension (IIH) and is sometimes a complication of definite IIH. Characteristic radiologic signs of IIH are common in spontaneous CSF leak patients, but little is known about changes in the distal transverse sinuses in patients with spontaneous CSF leak.

This case report demonstrates with imaging finding the connection between spontaneous CSF leak and idiopathic intracranial hypertension.

A 48-year-old obese woman with a remote history of IIH presented with a low CSF pressure headache and was found to have a spontaneous right sphenoid CSF leak. Brain MRI/MRV were normal without stigmata of intracranial hypertension, and specifically no narrowing of the distal transverse sinuses. About 10 days after CSF leak repair, despite low-dose Diamox (250 mg BID) and a 5-pound weight loss, she developed symptoms of intracranial hypertension. Repeat MRI/MRV showed increased optic nerve angles OU with optic nerve sheath tortuosity and reduction in the caliber of the transverse sinuses bilaterally. Acetazolamide was increased (1500 mg/day) and she lost 30 lbs. Symptoms improved, and acetazolamide was successfully tapered off. Repeat MRV showed no stenosis of the distal transverse sinuses. She never developed papilledema.

The MRI/ MRV imaging for this patient demonstrated the development of optic nerve sheath tortuosity and distal transverse sinus narrowing after repair of a spontaneous CSF leak, with the subsequent reversal of these findings after weight loss and treatment with Diamox, consistent with fluctuations in intracranial pressure.

This case supports the connection between spontaneous CSF leak and IIH, and supports reversible collapse of the distal transverse sinuses as part of the pathophysiology of fluctuating intracranial pressure.
Authors/Disclosures
Leanne Stunkel, MD (Washington University in St. Louis)
PRESENTER
Dr. Stunkel has nothing to disclose.
Amit Saindane Amit Saindane has nothing to disclose.
John DelGaudio No disclosure on file
Nancy J. Newman, MD, FAAN (Emory University School of Medicine) Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophoenix. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avidity. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophth. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Chiesi/Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $0-$499 for serving as a Consultant for Neurophoenix. The institution of Dr. Biousse has received research support from NIH. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.