title: Brain Slump Caused by Jugular Venous Stenoses Treated by Stenting: A Hypothesis to Link Spontaneous Intracranial Hypotension with Idiopathic Intracranial Hypertension.
abstract: Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) venography, catheter venography, and jugular venoplasty. CT venography showed narrowing of both internal jugular veins below the skull base. Catheter venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Higgins
authors.affiliation: Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Rikin
authors.initials: R
authors.lastname: Trivedi
authors.affiliation: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Greenwood
authors.affiliation: Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Pickard
keywords: brain slump; cranial venous outflow obstruction; idiopathic intracranial hypertension; jugular stenting; jugular venoplasty; spontaneous intracranial hypotension