Benign intracranial hypertension: Neuroradiology and endovascular treatments

Neuroimaging is useful in benign intracranial hypertension (BIH), contributing to its diagnosis criteria and ruling out other causes of intracranial hypertension. CT and/or MR results may be normal or may show small ventricles, an empty sella, or more frequently optic nerve sheath dilatation. Diffusion as well as perfusion MR studies show conflicting results. Venous sinus imaging plays a growing role in BIH evaluation, because impaired cranial venous outflow is a common factor in the pathogenesis of BIH and venous sinus stenosis is frequently observed in this condition. Angiography is not the gold standard for this evaluation: angio-MR (with dynamic sequences) clearly demonstrates venous sinus stenosis (mostly located in the transverse sinus). We believe that this investigation must be carried out in every case of BIH. For medically refractory cases of BIH with associated sinus venous stenosis, sinus pressure recording may be necessary, sometimes leading to endovascular treatment of the stenosis (stenting). The results are promising, but long-term follow-up of these patients is needed. (C) 2008 Elsevier Masson SAS. Tous droits reserves.