J Neurol Surg Rep 2015; 76(01): e188-e193
DOI: 10.1055/s-0035-1555015
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Brain Slump Caused by Jugular Venous Stenoses Treated by Stenting: A Hypothesis to Link Spontaneous Intracranial Hypotension with Idiopathic Intracranial Hypertension

Nicholas Higgins
1  Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Rikin Trivedi
2  Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Richard Greenwood
3  National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
,
John Pickard
4  Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
› Author Affiliations
Further Information

Publication History

16 January 2015

29 April 2015

Publication Date:
12 June 2015 (online)

Abstract

Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) venography, catheter venography, and jugular venoplasty. CT venography showed narrowing of both internal jugular veins below the skull base. Catheter venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.