Diagnosis: Pseudotumor Cerebri w/ right transverse sinus stenosis

History: 26 y.o. obese woman with a Hx of persistent and disabling (8/10) global headache and a recent onset of blurred vision

Findings: • MR Venogram (MRV) showing right transverse sinus stenosis, proximal to the sigmoid sinus and interntal jugular vein (IJV) junction. • Cerebral catheter arteriogram & venography demonstrate a high-grade right transverse-sigmoid sinus stenosis, distal to the vein of Labbe connection. The stenosis was estimated as at least 80% narrowing, to an approximate diameter of 1mm with a pressure gradient across the stenosis of 13 mmHg. • Neurointerventional radiology endovascular procedure was successful with a balloon angioplasty and stent placement across the stenosis in the right transverse sinus.

Ddx: • Obstruction of venous outflow, eg, venous sinus stenosis/thrombosis, jugular vein compression • Pseudotumor Cerebri (idiopathic intracranial hypertension) • Decreased CSF absorption (i.e. arachnoid granulation) • Increased cerebrospinal fluid (CSF) production (i.e. choroid plexus papilloma) • Intracranial mass lesions (tumor, abscess) • Obstructive hydrocephalus

Dxhow: Clinical presentation, MRV, & Cerebral Venogram

Exam: Ocular Exam: Papilledema & Ocular pressure of 46 cmH2O LP (spinal tap) – Opening Pressure of 20.5 cmH2O R Transverse sinus pressure gradient 13 mmHg (normal <4mmHg)