Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH A. Quattrone, MD; F. Bono, MD; R.L. Oliveri, MD, MSc; A. Gambardella, MD; D. Pirritano, MD; A. Labate, MD; A. Lucisano, MD; P. Valentino, MD; M. Zappia, MD; U. Aguglia, MD; A. Lavano, MD; F. Fera, MD; and K. Pardatscher, MD Article abstract—Background: There is evidence that patients with chronic daily headache (CDH) may have isolated intracranial hypertension without papilledema (IHWOP). Recent studies have emphasized that isolated IH may be due to cerebral venous thrombosis (CVT). Objective: To detect the occurrence of CVT in patients with CDH. Methods: The authors investigated the occurrence of CVT in 114 consecutive patients with CDH by using MR venography (MRV). A portion of these patients underwent a lumbar puncture (LP) to measure CSF pressure. MRV and LP were also performed in 28 age-matched control subjects. Results: In all the control subjects, both MRV and CSF pressure were normal. One hundred three of the 114 patients with CDH had normal MRV. Twenty-seven (Group 1) of these 103 patients underwent LP, and all of them had normal CSF pressure. Eleven (9.6%) of the 114 patients with CDH had CVT of one or both transverse sinuses. Six of these 11 patients had flowing abnormalities of one transverse sinus (Group 2), whereas the remaining five patients showed involvement of both transverse sinuses (Group 3). The CSF pressure of Group 2 was higher than that of either Group 1 or the control subjects, and one of the six patients showed isolated IHWOP. Patients of Group 3 displayed the highest CSF pressure, and four of five had isolated IHWOP. The headache profiles of patients with CDH and CVT did not differ from those of patients with CDH but normal MRV. Conclusions: CVT, as detected by MRV, occurred in 9.6% of patients who presented with CDH. Almost half of the patients with CVT had isolated IHWOP. These results suggest that MRV may be a useful tool for selecting patients with CDH who should have LP to exclude isolated IHWOP. NEUROLOGY 2001;57:31–36 Chronic daily headache (CDH) is a syndrome charac- terized by daily or near-daily headache, which in- cludes transformed migraine, chronic tension-type headache, hemicrania continua, and new daily per- sistent headaches. 1 CDH is a worldwide medical problem, and it has been recently reported that al- most 5% of the population experiences this syndrome. 2 In the last few years, studies have shown that a number of patients with severe CDH displayed idio- pathic intracranial hypertension without papill- edema (IHWOP) when investigated with a lumbar puncture (LP). Some authors 3 reported 10 patients with idiopathic IHWOP who presented with CDH, and others 4 found 12 cases of idiopathic IHWOP in a spinal fluid study of 85 patients with refractory CDH with migrainous features. Idiopathic IHWOP is a syndrome characterized by symptoms and signs of isolated IH without papill- edema and no other neurologic disease. 5 Recent studies 6-9 have emphasized that many patients with isolated IH (with or without papilledema) harbored cerebral venous thrombosis (CVT) when carefully in- vestigated through neuroimaging techniques such as cerebral venography or MR venography (MRV). On these grounds, it is reasonable to hypothesize that a proportion of patients who present with severe CDH may have CVT and isolated IHWOP. To ad- dress this issue, we studied 114 consecutive patients with CDH by using MRV, which has proven to be an effective noninvasive technique for detecting CVT. 10,11 We also investigated whether the presence of CVT identified patients with isolated IHWOP. Methods. One hundred forty-two subjects were included in this study: 114 patients with CDH and 28 control sub- jects. Informed consent was obtained from all subjects. Patients. One hundred fourteen patients (11 men and 103 women; mean age 38.9 years, SD 9.7 years) with CDH were consecutively enrolled from January 1998 until No- vember 1999 among the outpatients attending the Insti- tute of Neurology of Catanzaro. CDH was diagnosed according to the criteria of Silberstein et al. 1 Patients were enrolled if CDH lasted for at least 6 months. All the pa- tients were given the same standardized form to obtain headache, general medical (including body mass index: weight in kilograms divided by the square of height in From the Institutes of Neurology, (Drs. Quattrone, Bono, Oliveri, Gambardella, Pirritano, Labate, Lucisano, Valentino, Zappia, and Aguglia), Neurosurgery (Dr. Lavano), and Neuroradiology (Drs. Fera and Pardatscher), University Magna Græcia, Catanzaro; and Institute of Experimental Medicine and Biotechnology (Drs. Quattrone, Gambardella, and Oliveri), National Research Council, Piano Lago di Mangone, Cosenza, Italy. Received July 21, 2000. Accepted in final form March 3, 2001. Address correspondence and reprint requests to Prof. A. Quattrone, Cattedra e U.O. di Neurologia, Policlinico Materdomini, Via Tommaso Campanella, 88100 Catanzaro, Italy; e-mail: neurol.unicz@interbusiness.it Copyright © 2001 by AAN Enterprises, Inc. 31