Cerebral angiography as a tool for diagnosis and management of idiopathic intracranial hypertension syndrome

Purpose: Idiopathic intracranial hypertension syndrome (IIH) is a pathology characterized by headache, visual disturbances, papilledema, increased cerebrospinal fluid pressure with normal cytochemistry that is not attributable to cerebral structural alterations. This study aimed to describe the usefulness of cerebral angiography in the diagnostic approach and management of patients with clinical suspicion of IIH at a fourth level hospital in Cali, Colombia.

Methods: This was a retrospective study. Patients diagnosed with IIH at the hospital [Blinded], Cali, Colombia, from October 2013 to May 2018 were included. Their medical records were reviewed, and clinical and diagnostic variables were collected along with outcomes and follow-up data.

Results: A series of 13 cases, 12 women and 1 man, between the second and fifth decade of life, with an average age of 29.4 years were included. All presented with headache; 12 had papilledema (92%), and diplopia and palsy of cranial nerve VI were observed in 3 cases (46%). All patients underwent simple CT scan of the brain and simple and gadolinium-enhanced MRI of the brain, none of which showed lesions that would explain the intracranial hypertension; however, upon resonance angiography followed by cerebral angiography, 8 cases (61%) of cerebral venous sinus involvement were found.

Conclusion: Patients who present with a clinical picture compatible with IIH should undergo intra-arterial digital subtraction angiography (IADSA) to rule out cerebrovascular alterations.