MRI often shows typical signs of increased intracranial pressure, such as a flattened pituitary gland (empty sella), tortuous optic nerve, often with a dilated optic nerve sheath, or narrowing of the draining veins (stenosis of the transverse sinus). Thromboses of the draining cerebral veins are also frequently observed. The extent to which thrombosis is causal or a consequence of increased intracranial pressure has not yet been clarified.

Typical image findings of intracranial hypertension on MRI

(A) The image shows a distinctly flattened pituitary gland (Empty sella).
(B) The image shows a tortuous optic nerve (blue arrows), which has dilated nerve sheaths (white fluid border) on both sides.​​​​​​​
(C) Another image shows the veins draining the brain. Here, the clear constriction (syn. stenosis) in the area of the transverse sinus is visible on both sides (red arrows).

In recent years, endovascular therapy has become an important pillar of intracranial hypertension. In this procedure, a stent is inserted in the area of constriction of the draining cerebral veins (stenosis in the transverse sinus). This improves venous outflow from the brain, which in turn improves the reabsorption of cerebrospinal fluid into the blood via the Pacchioni granulations, ultimately leading to a reduction of intracranial pressure.

Endovascular treatment of a transverse sinus stenosis in a patient with intracranial hypertension
(A)  Baseline image shows a high-grade, long-stretch stenosis of a major cerebral vein (yellow arrow; transverse sinus).
(B) The stent (green arrows mark the stent) was placed at the level of the vessel narrowing.
(C) The final image after deployment of the stent shows a patent vessel lumen and complete reduction of the stenosis.