Repeat venous sinus stenting for management of recurrent sinus stenosis related treatment failure of idiopathic intracranial hypertension: A case series.

BackgroundDural venous sinus stenting (VSS) has been shown to be an effective treatment for idiopathic intracranial hypertension (IIH); however over time, some patients develop treatment failure with formation of a juxta-stent stenosis and a new pressure gradient. Repeat stenting can be performed in these patients to alleviate the stenosis and relieve the elevated pressures preventing complications such as blindness. The efficacy and long-term outcomes of re-stenting is not well described in the literature.

Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects.

Purpose: Superficial siderosis, a progressive, debilitating, neurological disease, often presents with bilateral impairment of auditory and vestibular function. We highlight that superficial siderosis is often due to a repairable spinal dural defect of the type that can also cause spontaneous intracranial hypotension.

Methods: Retrospective chart review of five patients presenting with moderate to severe, progressive bilateral sensorineural hearing loss as well as vestibular loss.

Transverse Sinus Stenting Reverses Medically Refractory Idiopathic Intracranial Hypertension.

Aim: To characterise the ophthalmic indications for, and ophthalmic efficacy of, transverse sinus stenting in adults with medically refractory idiopathic intracranial hypertension.

Methods: A retrospective cohort study was undertaken on a single-author database of 226 successive patients with confirmed idiopathic intracranial hypertension (IIH). A total of 32 patients were identified who received a transverse sinus stent for medically refractory disease.

Fatal reversible cerebral vasoconstriction syndrome.

We report four fatal cases of fulminant reversible cerebral vasoconstriction syndrome, all initially diagnosed as primary central nervous system vasculitis and treated with corticosteroids. Although reversible cerebral vasoconstriction syndrome is usually self-limiting without permanent neurologic deficits, rarely it can be fatal and worse outcomes have been associated with corticosteroid treatment.

Contrast-induced transient cortical blindness.

We present a case of transient cortical blindness secondary to contrast medium toxicity. A 58-year-old man had successful endovascular coiling of a right posterior inferior cerebellar artery aneurysm but became confused and unable to see after the procedure. His visual acuity was no light perception bilaterally.

Venous hypertension as the cause of intracranial hypertension in patients with transverse sinus dural arteriovenous fistula.

We describe 2 patients with transverse sinus dural arteriovenous fistulas (DAVFs) who presented with headache and papilledema due to intracranial hypertension. It has been proposed, but never proven, that venous hypertension causes the intracranial hypertension in DAVF. The data from our patients support this hypothesis.

Interventional treatment of carotid cavernous fistula.

We reviewed retrospectively the outcomes of interventional endovascular treatment of direct or dural (indirect) carotid cavernous fistulas in 24 consecutive patients requiring endovascular treatment at Royal Prince Alfred Hospital between 1994 and 2009. Data was collected from each patient's neurological, ophthalmological and radiological reports. Of the 12 patients with direct fistulas all had signs of orbital and ocular venous congestion and ophthalmoplegia; nine also had reduced vision ranging from 6/9 to nil perception of light, two had normal vision and one was unconscious.

Imaging of endolymphatic hydrops in Meniere's disease at 1.5 T using phase-sensitive inversion recovery: (1) demonstration of feasibility and (2) overcoming the limitations of variable gadolinium absorption.

Endolymphatic hydrops is the primary histopathological finding in Meniere's disease. We demonstrate the feasibility of imaging endolymphatic hydrops at 1.5 T using phase-sensitive inversion recovery (PS-IR) MRI following intratympanic injection of gadolinium (Gd).