Reader response: Idiopathic intracranial hypertension: The veno glymphatic connections

The Medical Hypothesis article by Lenck et al.1 provided an exciting new angle on recent findings concerning CSF circulation in the brain. The authors succinctly summarized clinical and radiologic evidence supporting their hypothesis that dysfunction of veno glymphatic connections lies at the heart of idiopathic intracranial hypertension (IIH). In particular, the authors speculated that chronic overflow of CSF in the sheaths of the olfactory bulbs may result in CSF rhinorrhea by eroding the cribriform plate.1 Olfactory dysfunction, especially a marked impairment in olfactory threshold levels, is an even more common yet underrecognized presentation of IIH.2,3 Indeed, as early as 2008, Dr. Kapoor4 speculated that dysfunction of the extensive lymphatic network around the olfactory nerves might be causally linked to IIH, making hyposmia a more sensitive predictor of IIH than other clinical features.

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