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Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH

From the Institutes of Neurology, (Drs. Quattrone, Bono, Oliveri, Gambardella, Pirritano, Labate, Lucisano, Valentino, Zappia, and Aguglia), Neurosurgery (Dr. Lavano), and Neuroradiology (Drs. Fera and Pardatscher), University Magna Græcia, Catanzaro; and Institute of Experimental Medicine and Biotechnology (Drs. Quattrone, Gambardella, and Oliveri), National Research Council, Piano Lago di Mangone, Cosenza, Italy.

Address correspondence and reprint requests to Prof. A. Quattrone, Cattedra e U.O. di Neurologia, Policlinico Materdomini, Via Tommaso Campanella, 88100 Catanzaro, Italy; e-mail: neurol.unicz{at}interbusiness.it

BACKGROUND: There is evidence that patients with chronic daily headache (CDH) may have isolated intracranial hypertension without papilledema (IHWOP). Recent studies have emphasized that isolated IH may be due to cerebral venous thrombosis (CVT).

OBJECTIVE: To detect the occurrence of CVT in patients with CDH.

METHODS: The authors investigated the occurrence of CVT in 114 consecutive patients with CDH by using MR venography (MRV). A portion of these patients underwent a lumbar puncture (LP) to measure CSF pressure. MRV and LP were also performed in 28 age-matched control subjects.

RESULTS: In all the control subjects, both MRV and CSF pressure were normal. One hundred three of the 114 patients with CDH had normal MRV. Twenty-seven (Group 1) of these 103 patients underwent LP, and all of them had normal CSF pressure. Eleven (9.6%) of the 114 patients with CDH had CVT of one or both transverse sinuses. Six of these 11 patients had flowing abnormalities of one transverse sinus (Group 2), whereas the remaining five patients showed involvement of both transverse sinuses (Group 3). The CSF pressure of Group 2 was higher than that of either Group 1 or the control subjects, and one of the six patients showed isolated IHWOP. Patients of Group 3 displayed the highest CSF pressure, and four of five had isolated IHWOP. The headache profiles of patients with CDH and CVT did not differ from those of patients with CDH but normal MRV.

CONCLUSIONS: CVT, as detected by MRV, occurred in 9.6% of patients who presented with CDH. Almost half of the patients with CVT had isolated IHWOP. These results suggest that MRV may be a useful tool for selecting patients with CDH who should have LP to exclude isolated IHWOP.

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