[Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?]. / Trombosis de senos venosos cerebrales en el diagnostico diferencial de la hipertension intracraneal idiopatica en mujeres jovenes obesas: un problema real?

INTRODUCTION: Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. PATIENTS AND METHODS: The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. RESULTS: A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. CONCLUSIONS: Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan.

Trombosis de senos venosos cerebrales en el diagnóstico diferencial de la hipertensión intracraneal idiopática en mujeres jóvenes obesas: ¿un problema real? / Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?

Introducción. La hipertensión intracraneal idiopática (HICI) se presenta típicamente en mujeres jóvenes con obesidad o aumento de peso reciente. En el diagnóstico diferencial de la HICI se encuentra la trombosis de los senos venosos cerebrales (TSVC), que también puede presentarse como un síndrome de hipertensión intracraneal aislada. Revisamos la frecuencia con la que pacientes con un perfil típico de HICI presentaron como diagnóstico una TSVC. Pacientes y métodos. Se revisaron de forma retrospectiva todos los ingresos por síndromes de hipertensión intracraneal en nuestro centro entre 2000 y 2011. Se seleccionaron los casos con tomografía axial computarizada craneal y estudio de líquido cefalorraquídeo normal que se presentaron como un síndrome de hipertensión intracraneal aislado, excluyéndose los que manifestaron clínica neurológica focal. Entre los pacientes incluidos, se seleccionó el subgrupo de mujeres entre 16 y 35 años con un índice de masa corporal superior a 25. Resultados. Se obtuvieron 37 casos. De éstos, 35 (94,6%) fueron casos de HICI y dos (5,4%) de TSVC. El tiempo desde el inicio de los síntomas hasta el diagnóstico fue menor de siete días en los dos casos (100%) de TSVC y en dos (5,4%) de HICI. Conclusiones. Hasta un 5,4% de los pacientes con perfil típico de HICI que se presentan con un síndrome de hipertensión intracraneal pueden presentar una TSVC. La presencia de factores protrombóticos y un dímero D elevado pueden orientar hacia esta posibilidad, aunque se precisan todavía parámetros bien establecidos que permitan la toma de decisiones en urgencias en ausencia de la posibilidad de una fleborresonancia craneal urgente (AU)

Introduction. Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. Patients and methods. The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. Results. A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. Conclusions. Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan (AU)