Letter regarding article: Cerebral venous etiology of intracranial hypertension and differentiation from idiopathic intracranial hypertension

I read with interest the article by Iencean et al. [1] in which they suggest that differentiation of intracranial hypertension (ICH) is associated with venous sinus stenosis and thrombosis in a subgroup of patients with vascular etiology of ICH. I appreciate such a long-term prospective study with a large number of cases. Nonetheless, I would like to comment on some aspects of the article and raise some issues for clarification and discussion by the authors. First, they suggested that intracranial venous sinus thrombosis and stenosis were the main etiological factors for idiopathic intracranial hypertension (IIH) in previous studies by Degnan et al. [2] and Farb et al. [3]. However, in my opinion, Degnan et al. [2] point out the utility of Magnetic Resonance Venography for detecting cerebral venous sinus thrombosis (CVST) and sinus narrowing, and they explain the sinus stenosis in association with IIH rather than a cause, and emphasize CVST as an etiological factor for symptoms of ICH and not the cause of IIH itself. Furthermore, Farb et al. [3] also report the frequent coexistence of sinovenous stenosis in conjunction with IIH rather than as a secondary cause of IIH. In the literature, the association of IIH and sinus stenosis is a well-known entity, meanwhile, the causeeeffect relation of these two pathologies is not clear, and some reports suggest a synergistic relation between them [2e4]. Hence, I think that the rationale for categorizing patients with stenotic sinuses in a group with ICH of vascular etiology may be questioned. There may be some debate about the study design and interpretation of the results. One point is that the criteria for evaluation of sinus stenosis should be