Endovascular stenting of bilateral hypoplastic jugular bulb in a toddler with elevated intracranial pressure: a case report.

We report a 3-year-old boy with macrocephaly, papilledema, and headaches associated with bilateral hypoplastic jugular bulbs leading to intracranial hypertension. Initial imaging was misinterpreted as idiopathic intracranial hypertension, and medical therapy with acetazolamide failed. Repeat MRI/MRV demonstrated thrombosis of the right transverse sinus with orbital collateral drainage. Angiography confirmed occlusion of the right jugular bulb and severe stenosis of the left. Due to progressive symptoms and developmental risk, rescue endovascular stenting of the right internal jugular vein was performed using a transvenous approach with angioplasty and deployment of a 7×30 mm stent. The procedure restored venous outflow and relieved congestion without complications. Intracranial pressure normalized, papilledema resolved, and neurocognitive improvement was observed at 6 months. At 9-month follow-up, MRI/MRV demonstrated occlusion of the right internal jugular vein stent. Despite this finding, follow-up ophthalmologic evaluation showed sustained improvement in papilledema. The patient remained clinically stable without recurrence of headaches or ocular congestion. This first-reported case of congenital bilateral jugular bulb hypoplasia treated with venous stenting highlights the importance of recognizing venous outflow anomalies as potential causes of pediatric intracranial hypertension.