Intracranial hypertension secondary to cervical dural arteriovenous fistula

Idiopathic intracranial hypertension (IIH) is a disease of mainly unknown etiology. Latest theories as to the pathogenesis have postulated a final common pathway of cerebral venous hypertension secondary to venous outflow impairment leading to decreased cerebrospinal fluid absorption. We present the case of a 42-year-old female who was treated for several years for headache and for approximately 12 months for IIH until appropriate imaging showed a right-sided cervical dural arteriovenous fistula (AVF) at the level of C4. The patient's IIH symptoms resolved following surgical excision of the fistula. We suggest that the cranial venous outflow impairment secondary to the cervical AVF was responsible for intracranial hypertension and that complete investigation of IIH patients should include imaging of the neck vasculature.