Brief report
Pseudotumor Cerebri Syndrome and Giant Arachnoid Granulation: Treatment with Venous Sinus Stenting

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The authors describe a patient with pseudotumor cerebri syndrome who showed at venography a giant arachnoid granulation in the left dominant transverse sinus and hypoplasia of the contralateral transverse sinus with high pressure proximal to the obstruction. Dilation of the left transverse sinuses with a stent reduced both the pressure gradient across the arachnoid granulation and the cerebral spinal fluid opening pressure with immediate symptomatic improvement, suggesting a causal relationship between venous outflow obstruction and pseudotumor cerebri syndrome.

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Case Report

A 34-year-old woman (body mass index, 26.1 kg/m2) presented with a 26-month history of headache and blurred vision. The physical examination was normal except for bilateral papilledema and a nasal effacement with peripapillary hemorrhages in the right optic disk. Magnetic resonance images were normal. A lumbar puncture in lateral decubitus showed an opening pressure of 400 mm H2O, and the patient was diagnosed with pseudotumor cerebri syndrome. Acetazolamide and furosemide were ineffective.

Discussion

Whether the giant arachnoid granulation is the cause or effect of pseudotumor cerebri syndrome is not yet known, and the role and mechanisms of venous sinus stenosis in pseudotumor cerebri syndrome remain controversial (3, 4).

Some authors have suggested that giant arachnoid granulations might be responsible for pseudotumor cerebri syndrome by obstructing the sinusal venous flow (5). According to Quattrone et al (5), venous outflow obstruction of one or both transverse sinuses, which occurs in

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None of the authors have identified a conflict of interest.

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