Treatment of refractory idiopathic intracranial hypertension (IIH) is a challenging problem. We reported a refractory IIH patient who manifested with typical intracranial hypertensive symptoms successfully treated with endovascular stent implantation. Pre-operative cerebrospinal fluid (CSF) opening pressure is 36 cmH2O. Cerebral angiography demonstrated a stenotic lesion located at the right transverse sinus (TS). The stenotic TS returned to its normal caliber and the pressure gradient deceased from 36 mmHg to 4 mmHg after the stent placement. The intracranial hypertensive symptoms resolved and one month later, the CSF opening pressure decreased to 14 cmH2O.
Cerebral Angiography ; Female ; Humans ; Middle Aged ; Pseudotumor Cerebri ; diagnostic imaging ; surgery ; Transverse Sinuses ; diagnostic imaging ; surgery

OBJECTIVETo study the clinicopathological characteristics diagnosis, differential diagnosis and etiology of demyelination pseudotumors of the brain.

METHODSThe clinical features, CT, MRI scan findings, corticosteroid therapeutic effects and follow-up data of 3 cases of demyelination pseudotumors of the brain were analysed, and pathological changes were observed by histologic (HE, Luxol fast blue and Bodian) and immunohistochemical (S-P method) techniques.

RESULTSThe acute onset of demyelination pseudotumors appeared to be more predominant in our data. Clinical manifestations included headache, vomiting, a depressed conscious level, dysphasia, and paresis. CT, MRI scans showed solitary or multiple lesions in cerebral hemisphere. All the patients presented excellent response to steroid treatment. Follow-up for a period of 6 to 31 months, revealed the absence of progression or recurrence. The pathological changes were mainly located in both cerebral hemispheres, in which there were relative axonal preservation in foci loss of myelin, reactive gliosis, profuse perivascular lymphocytic infiltration and mixtures of foamy macrophages.

CONCLUSIONDemyelination pseudotumor is a distinct clinicopathologic encephalitic entity. The findings of this study suggest that the cause of tumefactive demyelination may be related to an allergic reaction triggered by viral infection.

Adolescent ; Adult ; Demyelinating Diseases ; diagnostic imaging ; metabolism ; pathology ; physiopathology ; Female ; Humans ; Immunohistochemistry ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pseudotumor Cerebri ; diagnostic imaging ; metabolism ; pathology ; physiopathology ; Tomography, X-Ray Computed ; methods