Transverse sinus pathologies, vestibular migraine and intracranial hypertension without papilledema

Mamikoglu B., Algın O., Mengü G., Erdoğan-Küçükdağlı F., Kessler A.

American Journal of Otolaryngology - Head and Neck Medicine and Surgery, vol.44, no.5, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 44 Issue: 5
  • Publication Date: 2023
  • Doi Number: 10.1016/j.amjoto.2023.103931
  • Journal Name: American Journal of Otolaryngology - Head and Neck Medicine and Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Biotechnology Research Abstracts, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Veterinary Science Database
  • Keywords: Air-bone gap, CSF flow, CSF volume, Dural sinus stenting, Endolymphatic hydrops, Episodic vertigo, Increased intracranial pressure, Meniere, Migraine, Positional vertigo, Transverse sinus stenosis, Vestibular migraine
  • Ankara Haci Bayram Veli University Affiliated: Yes


Background: In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine. Cases: This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022. Results: The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm H2O. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent. Conclusion: A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.