Increased Intracranial Pressure With Normal Ventricular Size due to Superior Vena Cava Obstruction

To the Editor.  —Impaired venous outflow from the head can cause increased intracranial pressure. Both hydrocephalus (HC)¹ and intracranial hypertension with normal ventricular size² have been described in patients with diminished venous return. We describe a patient with superior vena cava (SVC) obstruction, who had increased intracranial pressure and normal ventricular size.

Report of a Case.  —An 80-year-old man was admitted after an episode of abnormal motor movements. His behavior had recently been characterized by inactivity and periods of staring, as well as several episodes of posturing and unresponsiveness. He had a history of poor vision and heavy alcohol consumption and had been hospitalized once for a possible "stroke."Initial examination revealed stigmata of cirrhosis and portal hypertension, including hepatosplenomegaly and "spider" angiomata. The patient was alert and oriented and had a mild dementia. His visual acuity was 20/60 bilaterally, with funduscopic findings remarkable only for pale discs.