Magnetic Resonance Venogram Research Articles

Cerebral vein thrombosis due to meningococcal meningitis

Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.

Complication of Brain Disease During a Radiological Intervention-an Alleged Case of Medical Negligence

Infections are the most common predisposing factor both in neonates and children, followed by hematological states, dehydration and various other conditions. Cerebral sino-venous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. Timely diagnosis and treatment are critically important for optimizing outcome. Twenty three months old male child with complaints of vomiting and abnormal eye movements (more on left side) was admitted in a hospital. To rule out intracranial pathology for asymmetrical movements, the child was advised Contrast MRI of Brain. At 08:00 pm, he was given Inj. Gadodiamide (Omniscan) 0.5 mmol/ml solution for contrast imaging. The child developed sudden cardiac arrest immediately after MRI scan was completed, at 08:50 pm and declared as dead at 09:40 pm. MR Venogram showed thrombus in superior sagittal sinus, proximal part of transverse sinuses & part of straight sinus. Non-Visualization of cerebral cortical veins on both sides was suggestive of thrombosis. Autopsy was performed by board of doctors after a complaint of medical negligence was made by the parents of the deceased. After perusal of clinical record, post-mortem report and FSL report, the board was of the considered opinion that findings were suggestive of thrombus in superior sagittal sinus and proximal part of transverse sinus and in cortical veins of both cerebral hemispheres and was a sudden natural death.

Susceptibility mapping of the dural sinuses and other superficial veins in the brain

Quantitative susceptibility mapping (QSM) is a means to obtain direct measurements of local tissue susceptibility distribution. Usually the focus is on imaging tissues in the brain, and the region of the brain studied is dictated by an eroded skull stripped mask. Producing the pristine local phase behavior for regions at the edge of the brain has been difficult in the past. For structures such as the superior sagittal sinus (SSS) that run alongside the surface of the brain and under the skull bones, a considerable part of the external phase from the dipole effect is lost due to the short T2* of the bones. In this paper, we propose a method that seeks to reconstruct the susceptibility distribution inside the dural sinuses by ensuring that the entire geometry of the dural sinuses is preserved with the help of an MR angiogram and venogram (MRAV). Having a geometrical model of the vessels makes it possible to estimate the missing phase outside the brain as well, by using the forward phase model and, hence, allowing a complete phase map to be reconstructed. Fifteen healthy volunteers were scanned using a susceptibility weighted imaging (SWI) sequence with interleaved rephased-dephased echoes. QSM results were compared between the conventional techniques and the proposed method of phase preservation outside the brain and inside the dural sinuses. This method demonstrates the reconstruction of the SSS, whereas conventional methods are either unable to preserve this structure or unable to provide complete phase information. The mean and standard deviation inside the SSS for all volunteers was 435 ± 5 ppb (this is the inter-subject error). To validate the proposed approach, the mean susceptibility inside the straight sinus showed good agreement between conventional approach and the proposed method. The results presented in this study indicate the potential of generating the susceptibility map for the whole brain, including the SSS (as well as potentially all the cortical veins).

Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses.

Cerebral venous sinus thrombosis (CVST) is a known complication of surgeries near the major dural venous sinuses. While the majority of CVSTs are asymptomatic, severe sinus thromboses can have devastating consequences. The objective of this study was to prospectively evaluate the true incidence and risk factors associated with postoperative CVST and comment on management strategies. A prospective study of 74 patients who underwent a retrosigmoid, translabyrinthine, or suboccipital approach for posterior fossa tumors, or a supratentorial craniotomy for parasagittal/falcine tumors, was performed. All patients underwent pre- and postoperative imaging to evaluate sinus patency. Demographic, clinical, and operative data were collected. Statistical analysis was performed to identify incidence and risk factors. Twenty-four (32.4%) of 74 patients had postoperative MR venograms confirming CVST, and all were asymptomatic. No risk factors, including age (p = 0.352), BMI (p = 0.454), sex (p = 0.955), surgical approach (p = 0.909), length of surgery (p = 0.785), fluid balance (p = 0.943), mannitol use (p = 0.136), tumor type (p = 0.46, p = 0.321), or extent of resection (p = 0.253), were statistically correlated with thrombosis. All patients were treated conservatively, with only 1 patient receiving intravenous fluids. There were no instances of venous infarctions, hemorrhages, or neurological deficits. The rate of CSF leakage was significantly higher in the thrombosis group than in the nonthrombosis group (p = 0.01). This prospective study shows that the radiographic incidence of postoperative CVST is higher than that previously reported in retrospective studies. In the absence of symptoms, these thromboses can be treated conservatively. While no risk factors were identified, there may be an association between postoperative CVST and CSF leak.

Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography

Background and purposeIt is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy...

Decompressive Hemicraniectomy Versus Medical Management in Cerebral Venous Thrombosis with Signs of Raised Intracranial Pressure

Background: Mass effect is the major cause of death in cortical venous sinus thrombosis and there is no clear cut the role of decompressive hemicraniectomy. Aims: To study the outcome of patients with large venous infarct and acutely increased intracranial pressure subjected to either conservative treatment or decompressive surgery. Materials & Methods: 20 consecutive patients admitted with moderate to large venous infarct were examined for features of raised intracranial pressure (ICP) . Cranial CT and or MRI and CT venogram or MR venogram and or cerebral DSA were examined for site of Sino venous occlusion. Results: There were 20 patients with 10 each in conservatively and surgically treated group. Cranial CT/MRI head revealed large venous infarct with midline shift and mass effect in all patients. Overall 15 of 16 survivors had good outcome at 3 months without any significant residual deficit irrespective of mode of treatment used. There is no statistical difference between medical and surgical groups in mRS 1 month, 3 months and death with p value 0.651, 0.185 and 0.474 respectively. Conclusion: Patient with large venous infarct with signs of raised intracranial pressure carries good overall outcome with timely care irrespective of conservative or surgical management.

Abstract WP59: A Clot Burden Score Predicts Functional Outcome and Neurological Complications After Cerebral Venous Sinus Thrombosis

Background and purpose: Involvement of deep venous structures is associated with worse outcomes in patients with cerebral venous sinus thrombosis (CVST); however, the impact of clot burden has not been studied. The aim of this study was to assess the value of a novel quantitative clot burden score as an independent predictor of clinical outcomes. Methods: We retrospectively reviewed all patients admitted to University of Iowa Health Care with CVST between 2004-2014. All patients received standard of care medical management per AHA/ASA recommendations. The degree of the thrombosis was categorized in admission MR venograms as (partial=1 vs. complete occlusion=2). Clot burden scores were computed as the sum of the thrombosis degree in the following vessels: cerebral veins (cortical veins, internal cerebral, vein of Rosenthal, vein of Galen) and cerebral sinuses (superior sagittal, inferior sagittal, straight, torcula, transverse/sigmoid). The primary outcome was modified Rankin Scale (mRS) at discharge. Secondary outcomes included hemorrhage, infarction, and cerebral edema. Multiple regressions were conducted to examine effects of clot burden scores on each of the four outcomes. Results: 115 patients met inclusion criteria, 76 women, and mean age 42. Thrombosis in cerebral veins area was noted in 58(50%), clot burden score Median=4, IQR=2; while 108(96%) had thrombosis in the cerebral sinuses area, Median=4, IQR=5. Clot burden in cerebral veins (p=.005) but not in cerebral sinuses, was associated with worse discharge mRS, r= .22. This effect remained significant when adjusting for age and gender (p=.002), but not when adjusting for complications including ICH, infarct, edema. Importantly, higher clot burden score in the cerebral veins predicted ICH (OR=1.73, p<.001), infarct size (OR=1.66, p<.001), and edema (OR=1.71, p<.001). Conclusion: Quantitative clot burden measurement of the cerebral veins conveys additional prediction on outcomes of CVST. Our findings suggest that the worse clinical outcomes associated with clot burden in the cerebral veins may be mediated by ICH, infarct size, and/or edema. The structural differences between the cerebral veins and sinuses may play a role in the variability in clinical outcomes among patients with CVST.

Norethisterone enanthate-induced cerebral venous sinus thrombosis (CVST)

A 23-year-old East Indian woman with no significant medical history, except a depot-norethisterone enanthate injection taken 3 weeks prior to admission, presented with a gradually worsening headache for the past...

An interleaved sequence for simultaneous magnetic resonance angiography (MRA), susceptibility weighted imaging (SWI) and quantitative susceptibility mapping (QSM)

PurposeTo image the entire vasculature of the brain with complete suppression of signal from background tissue using a single 3D excitation interleaved rephased/dephased multi-echo gradient echo sequence. This ensures no loss of signal from fast flow and provides co-registered susceptibility weighted images (SWI) and quantitative susceptibility maps (QSM) from the same scan. Materials and methodsThe suppression of background tissue was accomplished by subtracting the flow-dephased images from the flow-rephased images with the same echo time of 12.5ms to generate a magnetic resonance angiogram and venogram (MRAV). Further, a 2.5ms flow-compensated echo was added in the rephased portion to provide sufficient signal for major arteries with fast flow. The QSM data from the rephased 12.5ms echo was used to suppress veins on the MRAV to generate an artery-only MRA. The proposed approach was tested on five healthy volunteers at 3T. ResultsThis three-echo interleaved GRE sequence provided complete background suppression of stationary tissues, while the short echo data gave high signal in the internal carotid and middle cerebral arteries (MCA). The contrast-to-noise ratio (CNR) of the arteries was significantly improved in the M3 territory of the MCA compared to the non-linear subtraction MRA and TOF-MRA. Veins were suppressed successfully utilizing the QSM data. ConclusionThe background tissue can be properly suppressed using the proposed interleaved MRAV sequence. One can obtain whole brain MRAV, MRA, SWI, true-SWI (or tSWI) and QSM data simultaneously from a single scan.

Internal Jugular Microembolic Signal Detection in a Patient with Cerebral Sinus Thrombosis Complicated by Pulmonary Embolism

A 40-year-old woman with prior history of headaches, left-sided weakness, and diplopia was diagnosed with right sigmoid and transverse sinus thrombosis; increased intracranial pressure and associated cerebral venous infarction that underwent 12 months anticoagulation and then stopped. She has been off anticoagulation for about a year then started not “feeling right,” and was diagnosed with pneumonia and pulmonary embolism. During her course of hospitalization, she presented with progressive headache, possible left-sided weakness, associated blurry vision, nausea, and vomiting. Magnetic resonance venogram (MRV) shows lack of flow-related signals within the left half of the distal superior sagittal sinus, left transverse sinus, and nonocclusive thrombus in the left sigmoid sinus. Mechanical sinus thrombectomy attempted without significant difference in clot burden. A transcranial Doppler (TCD) emboli monitoring exam was ordered and was performed on the bilateral internal jugular for 15 min each. Microembolic signals detected: 52 emboli per hour right internal jugular vein (IJV), and 32 emboli per hour left IJV. She was discharged on methazolamide, furosemide, topiramate, and lifelong warfarin. No major events have been reported since discharge from 2008 to 2016.

A Rare Case of Budd Chiari Syndrome Secondary to Anti Phospholipid Antibody Syndrome and Inherited Thrombophilia

Background: Budd Chiari Syndrome is a heterogenous condition characterised by hepatic venous outflow obstruction at the level of hepatic veins and/or inferior vena cava. Case Report: A 20 years old, non-alcoholic male presented with progressive abdominal distension, hematemesis and jaundice since 4 weeks with H/O similar complaints twice in the past 1 year for which he was hospitalised and managed conservatively with medications and blood transfusions On examination pallor+, icterus+, clubbing+, Absent pubic and axillary hair and testicular atrophy noted. Abdomen distended, ascites present. Engorged veins noted over anterior abdominal wall and flanks with direction of flow of blood below upwards and away from umbilicus. Hepatosplenomegaly: present patient was evaluated for the cause of cirrhosis of liver and screened for viral markers, Wilson's disease, autoimmune hepatitis are found to be negative. Color Doppler of hepatic veins revealed non-visualization of hepatic veins. MRI abdomen with MR venogram suggested: CLD with cirrhosis of liver, portal hypertension with ascites, caudate lobe hypertrophy causing retrohepatic IVC narrowing, non-visualisation of hepatic veins S/O Budd Chiari Syndrome. Coagulation profile: serum APLA IgG: 18.24 μ/ml (<10), Factor V functional:19% (70–120%), anti-thrombin III activity: 35% (80–120%), serum homocysteine: 5.77 μmoles/l (5.46–16.40), protein S functional: 41% (60–140%). Conclusion: This patient is classified as having antiphospholipid antibody syndrome as per presence of 1 lab and 1 clinical criteria. This patient is also having inherited thrombophilia along with APLA syndrome leading to the development of Budd Chiari Syndrome with cirrhosis of liver. The author has none to declare.

Diplopia as a sequel of unilateral neck dissection.

The purpose of this study was to discuss the underlying etiology of raised intracranial pressure and its sequel after unilateral internal jugular vein ligation. In addition, the management protocol for such rare cases has been discussed along with literature review. PubMed and Google were used to search the literature for cases of raised intracranial pressure with complications after unilateral internal jugular vein (IJV) ligation. Twelve case reports with 17 patients were identified. There were 13 male and 4 female patients ranging between the ages of 26 and 61 years. Headache (n = 12/17; 70.5%), diplopia (n = 10/17; 58.8%), impaired vision (n = 9/17; 52.9%), and aplasia or hypoplasia of the transverse sinus were seen in these patients. Although very rare, this potential complication after unilateral IJV ligation should be kept in mind. Magnetic resonance venogram (MRV) is the investigation of choice to ascertain the underlying etiology. Conservative management should be started immediately. Surgical options are reserved for patients with progressive symptoms. © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:E2475-E2478, 2016.

Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage.

Background/Object:The ligation and transection of anterior third of superior sagittal sinus (AT-SSS) is an important step to approach anterior skull base lesions. Some clinical studies have shown frontal lobe venous infarct following such surgical procedures questioning the safety of its ligation. We have studied the variations in venous drainage patterns to AT-SSS in the normal population using postcontrast magnetic resonance venogram (MRV). A novel scoring system to recognize the subgroup with dominant venous drainage from frontal lobes has been described.Materials and Methods:In this study, 60 three-dimensional contrast-enhanced (CE) MRVs were obtained from those cases being evaluated for a headache not harboring any intracranial mass lesion. The AT-SSS with all its draining veins was studied in detail. Morphology of individual veins such as length, caliber, tributaries, and angulation with AT-SSS was studied, and a numerical value of 0 or 1 was assigned for each of the above parameters. Summing up these scores derived from the individual cortical veins quantified the drainage of AT-SSS.Results:There are 3–4 veins on either side draining to AT-SSS. Barely, 3% of the veins had > 3 tributaries. Only 6.6% of veins had a caliber >3 mm, and 16.5% drained at acute angles to AT-SSS. About 26% of the veins did cross at least half of the lateral frontal lobe. We found in 26 individuals the AT-SSS score was 0–2, in 22 it was 3–5 and, in only in 12 (20%) the score was 6 or more (dominant drainage).Conclusion:There are anatomical variations in venous drainage of frontal lobes into AT-SSS. Those with dominant drainage are likely to develop venous congestion and complications if sacrificed. It is possible to identify these individuals on the basis of venous drainage pattern as shown in CE-MRV.

Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. • The venous anatomy of the neck in patients without MS demonstrates multiple variants • Asymmetry and stenoses of the internal jugular veins are common • Collateral neck veins are not uncommon in patients without MS • These findings do not support the theory of chronic cerebrospinal venous insufficiency • MR venography is a useful imaging modality for assessing venous anatomy.

An Unusual Association – Tuberculous Meningitis Causing Cerebral Venous Thrombosis

Hypercoagulable conditions are known to cause cerebral venous thrombosis (CVT), however, infection related CVT is rare. Thrombosis involving cerebral venous channel is less common than artery. Infection could be either bacterial or fungal in origin. Mycobacterium tuberculosis causing cerebral venous thrombosis is rarely reported. We report a 28 year postpartum lady, who presented with fever, headache, altered sensorium with right sided hemiparesis and signs of meningeal irritation. On evaluation, her cerebrospinal fluid analysis showed evidence of tuberculous infection, magnetic resonance venogram showed cerebral venous thrombosis. She was evaluated for other procoagulant conditions, which were negative. She improved with antitubercular, antiepileptics, anticoagulation medications.

Women's Neurology

This review details some of the features important to consider in women with neurologic disease, including medication and disease effects on both reproductive health and pregnancy/fetal development, as well as hormonal effects on neurologic disease. A case-based approach is used to discuss diseases that affect women throughout their life cycle (multiple sclerosis [MS] and epilepsy), disorders that affect only women (eclampsia), and those that affect women preferentially (migraine, cerebral venous thrombosis, reversible cerebral vasospasm, and Alzheimer disease). The epidemiology, differential diagnosis, pathophysiology, management, and prognosis are reviewed for each disorder. Tables include US Food and Drug Administration pharmaceutical pregnancy categories, learning objectives, migraine with aura, alternative diagnostic criteria for migraine without aura, migraine aura versus transient ischemic attacks, red flags to secondary headache, abortive headache therapy in pregnancy, migraine preventive medications and pregnancy, MS therapies in pregnancy, pregnancy consulting points for MS patients on a disease-modifying therapy, and general recommendations for women with epilepsy and pregnancy. Figures show fluid-attenuated inversion recovery and gradient echo magnetic resonance images of the right anterior parietal region; a magnetic resonance venogram demonstrating occlusion in the superior sagittal sinus; posterior reversible encephalopathy syndrome; and computed tomographic (CT) images of a hemorrhage in the left parietal region, left frontal subarachnoid bleeding, and left middle cerebral beading. This review contains 5 highly rendered figures, 11 tables, and 29 references.

Women's Neurology

This chapter reviews some of the features important to consider in women with neurologic disease, including medication and disease effects on both reproductive health and pregnancy/fetal development, as well as hormonal effects on neurologic disease. A case-based approach is used to discuss diseases that affect women throughout their life cycle (multiple sclerosis [MS] and epilepsy), disorders that affect only women (eclampsia), and those that affect women preferentially (migraine, cerebral venous thrombosis, reversible cerebral vasospasm, and Alzheimer disease). The epidemiology, differential diagnosis, pathophysiology, management, and prognosis are reviewed for each disorder. Tables include US Food and Drug Administration pharmaceutical pregnancy categories, learning objectives, migraine with aura, alternative diagnostic criteria for migraine without aura, migraine aura versus transient ischemic attacks, red flags to secondary headache, abortive headache therapy in pregnancy, migraine preventive medications and pregnancy, MS therapies in pregnancy, pregnancy consulting points for MS patients on a disease-modifying therapy, and general recommendations for women with epilepsy and pregnancy. Figures show fluid-attenuated inversion recovery and gradient echo magnetic resonance images of the right anterior parietal region; a magnetic resonance venogram demonstrating occlusion in the superior sagittal sinus; posterior reversible encephalopathy syndrome; and computed tomographic (CT) images of a hemorrhage in the left parietal region, left frontal subarachnoid bleeding, and left middle cerebral beading. This chapter contains 5 highly rendered figures, 11 tables, 29 references, and 5 MCQs.

Risk factors and early diagnosis of cerebral venous sinus occlusion secondary to traumatic brain injury.

This study was designed to investigate the risk factors of, and the strategy for early diagnosis of cerebral venous sinus occlusion (CVSO) secondary to traumatic brain injury. The clinical data of 240 consecutive patients were analyzed retrospectively. The clinical symptoms were observed and imaging was carried out. The risk factors of CVSO were evaluated with logistic regression analysis. Early diagnosis of CVSO was established based on the clinical and imaging features. Forty patients were diagnosed to be having CVSO according to the findings of computerized tomographic venogram (CTV) and magnetic resonance venogram (MRV). They were classified into three sub-types (thrombosis occlusion type, compression type, and mixed type). A skull fracture crossing the sinus (odds ratio [OR] =8.026; 95% confidence interval [CI]: 3.107-20.734) and an epidural hematoma crossing the sinus (OR = 3.062; 95% CI: 1.355-6.921) were risk factors associated with CVSO, and the former played a more significant role. The female gender (OR = 0.306; 95% CI: 1.715-61.943) was the risk factor for the thrombosis occlusion type of CVSO. An epidural hematoma crossing the sinus (OR = 5.653; 95% CI: 1.767-18.084) was the risk factor of the compression type of CVSO. The past medical history of deep vein thrombosis (DVT) (OR = 11.276; 95% CI: 1.315-96.664) combined with a skull fracture and epidural hematoma crossing the sinus were risk factors for the mixed type of CVSO. Paying close attention to the past medical history of DVT, skull fracture, and the imaging finding of an epidural hematoma that crosses the sinus are necessary for the early diagnosis of CVSO. CTV and MRV help in making an early diagnosis of CVSO.

Posterior Reversible Encephalopathy Syndrome in Pregnancy

ABSTRACT Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity characterized by several symptoms of varied etiologies. The common symptoms are headache, confusion, seizures, cortical visual disturbances or blindness. Here, we report a 22 years old lady with 32 weeks of gestation who presented with complaints of acute onset of headache, sudden loss of vision with elevated blood pressure (BP), whose magnetic resonance venogram (MR venogram) revealed bilateral occipital T2 hyperintensity with restriction of diffusion suggestive of PRES. Early identification and treatment usually results in complete reversal of the deficits and delayed diagnosis and improper management can lead to irreversible sequelae. How to cite this article Krupa BM, Sundari N, Madhusudhan BK, Swaroop A, Chaitra S. Posterior Reversible Encephalopathy Syndrome in Pregnancy. J South Asian Feder Obst Gynae 2015;7(3):205-206.

Leptomeningeal Carcinomatosis Mimicking Idiopathic Intracranial Hypertension with Transverse Sinus Stenosis

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