A 35-year-old male patient came to the emergency department complaining of bifrontoparietal headache of great intensity and 8 hours of duration, which did not vary with Valsalva manoeuvres or analgesics.
The patient reported an episode of IIH treated with oral acetazolamide and nephron with clinical recovery and disappearance of papilloedema.
The general and neurological examination was normal, with a body mass index of 22 kg/m2.
Examination revealed a corrected visual acuity of 0.7 in both eyes.
Intrinsic ocular motility, anterior segment examination and intraocular pressure (IOP) were normal.
Funduscopic examination showed bilateral papilledema.
Fluorescein angiography showed bilateral peripapillary leakage from early times.
Left bundle layer thickness (left bundle layer thickness) was measured using optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Dublin, CA) and showed normal thickened fibers.
Orbital ultrasound, computerized axial tomography and automatic perimetry were normal.
Lumbar puncture and opening pressure of 30 cm of water were performed, with normal CSF composition and serology.
Analytical and coagulation studies and determination of ANCAs, ANAs, CRP, FR, ASLO, thyroid hormones and antithyroid antibodies were negative.
After performing a nuclear magnetic resonance (NMR) and fleborrheonance, the presence of thrombosis of the cranial sinuses was ruled out, finding a segmental stenosis of the right lateral sinus.
The patient was treated with acetazolamide and established clinical improvement.
A long right transverse sinus stenosis with a pressure gradient of 7 mmHg, of little quantity and similar to that of the contralateral sinus was observed after venography and manometry of the cranial sinuses.
For this reason, dilation by angioplasty and stent placement is discarded due to clinical improvement.
