title: Orbital phlebography in idiopathic intracranial hypertension and chronic tension-type headache.
abstract: BACKGROUND
  Pathologic signs in orbital phlebographies have been reported in various neurological diseases.
  
  
  OBJECTIVE
  To study if pathologic signs in orbital phlebography may be markers of inflammation primarily affecting intracranial capillaries, which would cause intracranial hypertension.
  
  
  METHODS
  Two groups with different intracranial cerebrospinal fluid pressures (Pcsf) were compared as to inflammatory markers in serum and pathologic signs in orbital phlebographies. Nine consecutive patients with idiopathic intracranial hypertension (IIH) with bilateral papilledema and eight consecutive patients with chronic tension-type headache (CTTH) were investigated prospectively with fibrinogen, orosomucoid, haptoglobin in serum, and invasive orbital phlebograms. The angiograms were evaluated by two skilled neuroradiologists, independent of each other and without knowledge of the diagnoses or aim of the study, as to the following pathologic signs: (i) narrowing of superior ophthalmic veins; (ii) caliber changes of intraorbital veins; (iii) collaterals of intraorbital veins; (iv) flow to cavernous sinus; and (v) asymmetric drainage of cavernous sinus.
  
  
  RESULTS
  Mean body mass index was >30 kg/m(2) in both groups. Pcsf was >200 < 250 mm H2O in 50% of the CTTH and >350 mm H2O in all IIH patients. No difference in inflammatory markers in blood was found. The phlebographies of the IIH patients had more pathologic signs and were considered pathologic significantly more often than the ones of the CTTH patients (P < 0.001).
  
  
  CONCLUSIONS
  The difference as to phlebographic pathologic signs between the IIH and the CTTH patients with different Pcsf supports the hypothesis that such phlebographic signs are markers of inflammation primarily affecting intracranial capillaries, which would disturb cerebrospinal fluid regulation causing intracranial hypertension.
authors.affiliation: Karolinska Hospital, Solna - Neurology, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hannerz
authors.affiliation: Karolinska Hospital, Solna - Neuroradiology, Stockholm, Sweden.
authors.forename: Kaj
authors.initials: K
authors.lastname: Ericson
authors.affiliation: Karolinska Hospital, Solna - Neuroradiology, Stockholm, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Greitz
authors.affiliation: Karolinska Hospital, Solna - Neuroradiology, Stockholm, Sweden.
authors.forename: Pernille Hanne Bro
authors.initials: PH
authors.lastname: Skejo
authors.affiliation: Tiohundra AB, Norrtalje - Psychiatry, Norrtälje, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Edman
keywords: Idiopathic intracranial hypertension; chronic tension-type headache; low-grade capillaritis; orbital phlebography; venous vasculitis