Accumulating evidence challenges the traditional distinction between migraine and idiopathic intracranial hypertension (IIH). We tested whether impaired CSF volume/pressure regulation driven by dural venous sinus stenosis represents a shared substrate. Brain MRI and magnetic resonance venography scans from 161 consecutive patients-migraine without aura (MwoA, n = 89), migraine with aura (MwA, n = 36) and IIH (n = 36)-were retrospectively analysed and compared with 37 prospectively recruited healthy controls. An Extended Combined Conduit Score-designed to quantify the degree and extent of venous-sinus narrowing, with higher values indicating greater outflow impairment, and also evaluating the superior sagittal sinus-quantified stenosis. Additional neuroradiological markers of raised intracranial pressure (empty sella, posterior globe flattening and optic nerve sheath diameter) were recorded. A receiver operating characteristic analysis defined the optimal stenosis degree threshold for distinguishing patients from controls, after which prevalence comparisons were performed. Median Extended Combined Conduit Score increased step wise from controls (2, interquartile range 1-3) to MwoA (3, 2-4), MwA (3, 3-4) and IIH (6, 5-6) (P < 0.001). Both migraine groups scored higher than controls (P < 0.001) and lower than IIH (P < 0.001). The area under the receiver operating characteristic curve was 0.786 (95% confidence interval 0.716-0.856); a cut-off ≥3 provided 74.5% sensitivity and 73.0% specificity. Using this threshold, venous stenosis was more frequent in MwoA and MwA than in controls (each P < 0.001) and highest in IIH (P < 0.001 versus all); MwA exceeded MwoA (P = 0.007) and was comparable to IIH (P = 0.187). Bilateral stenosis occurred in 0% of controls, nearly 25% of patients with migraine (P < 0.001 versus controls) and 77.8% of IIH patients (P < 0.001). Empty sella was more common in MwoA (P = 0.004) and MwA (P = 0.025) than in controls, and markedly enriched in IIH (P < 0.001 versus all). Other radiological markers were similarly more prevalent in IIH (all P < 0.001) showing no additional significant between-group differences. Findings support a pathogenetic continuum linking MwoA, MwA and IIH, challenging the diagnostic primacy of papilledema, the rarity of IIH without it, and the perceived irrelevance of unilateral sinus narrowing. As already observed in IIH, an impaired intracranial volume/pressure regulation appears a necessary though not sufficient condition for migraine development; a 'primary' predisposition to migraine, likely multifactorial and widely variable among individuals and in the same individual over time, is required for typical migraine pain to develop, also modulating its frequency. Future studies should assess whether targeting intracranial pressure, thus potentially preventing calcitonin gene-related peptide release, may complement or substitute calcitonin gene-related peptide based therapies in migraine patients.

Camurati-Engelmann Disease (CED) is a rare sclerosing bone dysplasia in which skull-base hyperostosis may result in neuro-ophthalmic complications. We report a 21-year-old woman with presumed CED and known bilateral choroidal osteomas who presented with bilateral optic nerve swelling. Neuroimaging demonstrated diffuse cranial hyperostosis with optic canal narrowing but no definitive optic nerve compression or venous sinus thrombosis. Lumbar puncture confirmed raised intracranial pressure with an opening pressure of 33 cm H2O. Optical coherence tomography revealed right eye subretinal fluid without choroidal neovascular membrane. Papilloedema improved initially with acetazolamide, but treatment was changed to oral furosemide due to intolerance to acetazolamide. There was continued visual decline in association with progressive subretinal fluid. Right eye intravitreal bevacizumab was ineffective, while fovea-sparing photodynamic therapy achieved resolution of subretinal fluid but was complicated by retinal pigment epithelial and photoreceptor loss. At 2.5-year follow-up, visual acuity was reduced in both eyes, with mild bilateral chronic papilloedema and enlargement of choroidal osteomas. This case illustrates multifactorial visual loss in CED with skull base hyperostosis arising from raised intracranial pressure and co-existing retinochoroidal pathology. This is the first documented case of CED with bilateral choroidal osteomas and highlights the role of multimodal imaging and multidisciplinary collaboration.

A hydatid cyst is caused by Echinococcus granulosus. It is transmitted to humans via the feco-oral route. It occurs mostly in the liver or lungs. Intracranial occurrence is a very infrequent phenomenon. This review aimed to provide an insight into the clinicopathological spectrum of primary intracranial hydatid cyst and its management in Pakistani patients. Databases (PubMed and Google Scholar) and national journals were searched using predefined keywords from their inception until October 31, 2025. All case reports (CR), case series (CS), and original articles that satisfied the inclusion and exclusion criteria were included. A total of 11 studies were included, reporting data on 86 patients. The pooled mean age was 16.7 years, with a male predominance of 49 (59.03%). The median duration of illness was 12 (IQR: 6-12) months. The most frequently encountered symptoms were headache in 10/13 (76.90%), papilledema in 9/13 (69.20%), and motor deficit in 8/13 (61.50%). The most common location was supratentorial in 78/86 (90.70%), involving the fronto-parietal region in 21/83 (25.30%). Across the documented cases, the average diameter of the cyst was 8.81 cm. The lesion appeared hyperintense on T2 in six out of eight (75%) cases. Only 4/13 (30.79%) cases reported multiple cysts. Surgical management was opted for in all (86) cases. The Dowling technique was employed in 44 (51.16%), followed by excision in 41 (47.67%) cases. However, intraoperative cyst rupture was individually documented in three (23.07%) cases (from CR and CS). Postoperative meningitis was mentioned in only one CR. Medical therapy with albendazole was prescribed in nine (69.23%) cases, and it was continued for a mean of 28.80±28.89 weeks. The median duration of follow-up was 12 (IQR: 12-76) months. Recurrence was reported in three (23.07%) cases. Death was documented in 3/13 (23.07%) cases. Meticulously performing the Dowling technique is safer to avoid intraoperative rupture. Subsequently, drastic complications can be prevented. Surgery, along with anti-helminthic administration, ensures the complete resolution of intracranial hydatid cysts. Long-term follow-up is necessary to investigate the course of the disease and achieve complete remission.

Idiopathic intracranial hypertension (IIH) is a rare but significant complication in patients with systemic lupus erythematosus (SLE). Its diagnosis and management can be challenging, particularly in cases of recurrence. We report the case of a 26-year-old Persian female with a history of SLE and hypertension who presented with persistent headaches and bilateral papilledema. Diagnostic workup, including lumbar puncture, revealed elevated cerebrospinal fluid (CSF) pressure consistent with IIH, without evidence of infection or other secondary causes. Initial treatment with acetazolamide led to symptom resolution and normalization of CSF pressure. However, following the discontinuation of acetazolamide after a year of symptom-free follow-up, she experienced a recurrence of IIH. High-dose acetazolamide was readministered, resulting in remission. The patient was managed with continued follow-up and a multidisciplinary approach, including adjustments to her SLE and hypertension treatments. This case underscores the importance of long-term monitoring in patients with SLE who develop IIH. It highlights the potential for IIH recurrence after treatment withdrawal, emphasizing the need for individualized management strategies and a multidisciplinary approach to ensure optimal outcomes.

A previously healthy woman developed acute painless left-eye vision loss after travelling to Colombia, with recent febrile episodes and kitten exposure. Examination showed left neuroretinitis with papilledema and macular star. Bartonella henselae serology confirmed diagnosis. Treatment with doxycycline and rifampicin led to a gradual and complete visual recovery.