Recent concepts in the pathophysiology and treatment of pseudotumor cerebri [PTC]

ABSTRACT

Study the role of intracranial venous system in the pathophysiology of Pseudotumor cereberi. Twenty patients diagnosed as PTC according to Dandy diagnostic criteria. All underwent general and neurological assessment. Full ophthalmologic assessment. Full Laboratory investigations were done. Radiological assessment included CT scan brain +/- MRI brain without contrast, MRV of the intracranial venous system. All underwent digital subtraction cerebral Angiography [DSA] [venous phase] to confirm the validity of filing gaps seen at the level of MRV whether they are true stenosis or not. Menstrual irregularity documented in 2 patients [10%]. Sixteen patients [80%] considered to be overweight or obese. MRV brain showed that 14 patients [70%] showed filling gaps suggestive of sinus stenosis. However, digital subtraction cerebral angiography [venous phase] gave different data that only 5 patients [25%] had stenosis in their dural sinuses. MRV showed to be a good screening tool since it had 100% sensitivity and negative predictive value. Therefore, if MRV is normal no further investigations are needed. However, since it has a moderate specificity [62%] with a positive predictive value [PPV] of only 35%, then lesions detected should be confirmed with digital subtraction cerebral angiography [venous phase] particularly those involving the transverse and sigmoid sinus. In our study most of the cases having venous sinus stenosis occurred among patients with age between 22-30 y old [p<0.05] and among those with BMI>30 [p<0.05]. Significant association was found between visual symptoms and stenosis since 80% of cases with stenosis had diplopia, TVO's, grade 3 papilledema and in grade 3 field defect [p<0.05]. By logistic regression model, diplopia and TVO's were considered as independent predictors of occurrence of stenosis among the studied cases. Studying the intracranial venous system in patients with PTC is and important step in understanding the pathophysiology of the disease. Detection of venous sinus stenosis opens the way to a novel therapeutic option for refractory patients like venous sinus stenting