Bilateral Transverse Sinus Angioplasty for the Treatment of Idiopathic Intracranial Hypertension – Case Report and Literature Review

Abstract

Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in intracranial pressure, without presence of parenchymal lesions or hydrocephalus that justify it. Over 90% of cases there is association with stenosis of the dural venous sinuses. It is characterized by headache, tinidus, nausea, vomiting and visual disturbances. Initial treatment is clinical and when it fails there is indication of invasive procedures, among them shunts and fenestration of the optic nerve sheath. Angioplasty of dural venous sinuses, when indicated, has shown an alternative with better results and less complications. We report a case of a female patient, with 27 years old, diagnosed with IIH and bilateral transverse sinus stenosis, which was treated by bilateral stenting and total resolution of symptoms. Besides describing the case we review the literature about the subject.

Resumo

Hipertensão intracraniana idiopática (HII) é uma doença caracterizada pelo aumento da pressão intracraniana, sem a presença de lesões parenquimatosas ou hidrocefalia que a justifiquem. Em > 90% dos casos, há relação com estenose de seios venosos durais. O quadro clinico é caracterizado por cefaleia, tinnitus, náuseas, vômitos e distúrbios visuais. O tratamento inicial consiste em uma modalidade clinica, e quando esta é ineficaz, há indicação de procedimentos invasivos, dentre os quais estão as derivações liquóricas e a fenestração da bainha do nervo óptico. A angioplastia dos seios venosos, quando indicada, mostra-se uma alternativa com melhores resultados e com menos complicações. Relatamos o caso de uma paciente de 27 anos com diagnóstico de HII e estenose de seio transverso bilateral na qual o tratamento realizado foi o implante de stents, com melhora completa dos sintomas. Além do relato de caso, revisamos a literatura a respeito do assunto.

Keywords

intracranial hypertension - angioplasty - venous sinus stenosis

Palavras-chave

hipertensão intracraniana - angioplastia - estenose seio transverso

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