Leptomeningeal Carcinomatosis Mimicking Idiopathic Intracranial Hypertension with Transverse Sinus Stenosis

Abstract

Background: The most common form of pseudotumor cerebri occurs in obese young women in whom it can be caused by transverse sinus stenosis. Such cases used to be called idiopathic intracranial hypertension (IIH). However, leptomeningeal carcinomatosis can produce intracranial hypertention with papilledema, but without hydrocephalus. Case Report: A 48-year-old woman presented with blurred vision and headache for one month. Brain magnetic resonance imaging with contrast showed no abnormality, and lumbar puncture revealed elevated cerebrospinal fluid pressure with hypoglycorrhachia. A magnetic resonance venogram showed a transverse sinus stenosis. She was treated with stent placement within a transverse sinus stenosis, but her condition became progressively worse. Leptomeningeal carcinomatosis was finally confirmed by repeated analyses of cerebrospinal fluid. Conclusion: The cause of IIH is unclear and it remains a diagnosis of exclusion. When confronted by a patient with intracranial hypertension with hypoglycorrhachia, other cause must be excluded before diagnosing IIH. Key Words: Intracranial hypertension; Hypoglycorrhachia; Leptomeningeal carcinomatosis