The Case of a Patient with Idiopathic Intracranial Hypertension Who Required Additional Stenting for Stent-Adjacent Stenosis.

Objective: We report the case of a patient with recurred idiopathic intracranial hypertension (IIH) with transverse sinus (TS) stenosis after initial stenting, which was treated with additional stent placed in tandem to the secondarily occurred stent-adjacent stenosis (SAS). Case Presentation: A 41-year-old woman complained of reduced visual acuity and blurred vision, and presented with papilledema. Lumbar puncture revealed an opening pressure of 36 cmH2O. MRI revealed no space-occupying lesions, and the patient was diagnosed with IIH based on the modified Dandy criteria. MR venography revealed stenosis in the right and hypoplastic left TS. The patient complained of headache and neck pain after each lumbar puncture for examination. Venous sinus stenting (VSS) was performed in the right TS. One month after stenting, follow-up angiography revealed stenosis in the remaining parts of TS. Five months after stenting, IIH recurred, and SAS was detected on angiography. An additional stenting procedure was performed. Three months after the second treatment, her symptoms disappeared and cerebrospinal fluid pressure was normalized. Conclusion: Patients with post-VSS recurrent IIH may develop restenosis in the remaining parts of TS at variable progression speeds. In this case, angiography revealed gradually advancing stenosis that seemed to form SAS at the time of recurrence. If the initial VSS is effective for IIH, SAS can also be treated effectively and less invasively with a second stent placement covering the entire TS length.

[Isolated trigeminal neuropathy involved with motor dysfunction due to small infarction in the pontine tegmentum].

We present a case of isolated trigeminal neuropathy involved with motor dysfunction due to a small infarction in the pontine tegmentum. A 70-year-old man presented with sudden numbness around the left mouth accompanied by maxillary pain. Neurological examinations revealed jaw deviation to the left when opening the mouth, but no other abnormal findings including those of the cranial nerves were detected. X-rays indicated hypomobility of the left temporomandibular joint, and diffusion-weighted magnetic resonance imaging (MRI) revealed a small infarction in the left pontine tegmentum. Unilateral limitation of the temporomandibular joint movement, numbness, and pain in the territory of the left trigeminal nerve resolved within 2 months. This case suggests that a small infarction in the pontine tegmentum can simultaneously cause trigeminal neuralgia and masticatory muscle weakness with no other symptoms and signs. MRI, especially diffusion-weighted imaging, should be considered for patients with isolated trigeminal neuropathy.