The Upper Limit of Normal CSF Opening Pressure is Related to Bilateral Transverse Sinus Stenosis in Headache Sufferers

There are limited data on the relationship between normal cerebrospinal fluid (CSF) opening pressure and bilateral transverse sinus stenosis (BTSS); there are also several conflicting reports about the upper limit of normal CSF opening pressure. To evaluate the influence of BTSS on the upper limit of normal CSF opening pressure, we prospectively recorded lumbar CSF opening pressures in 217 adult patients with neurological symptoms who underwent cerebral magnetic resonance venography (MRV). The CSF opening pressures ranged between 65 and 286 mmH(2)O (mean = 149.3, s.d. = 47.5). The upper limit of opening pressure in patients with both normal appearance of transverse sinuses and unilateral transverse sinus stenosis on MRV (n = 167) was 195 mmH(2)O with a range of 65-195 mmH(2)O. All patients with BTSS were headache sufferers, and the upper limit of opening pressure in patients with BTSS (n = 50) was 286 mmH(2)O with a range of 91-286 mmH(2)O. All patients with opening pressures > 200 mmH(2)O displayed BTSS, whereas only 13% of patients with a pressure < 200 mmH(2)O displayed BTSS. Our findings demonstrate that the upper limit of normal CSF opening pressure is related to BTSS, and they also highlight that headache sufferers with opening pressures > 200 mmH(2)O should be tested for BTSS by MRV.