The review of neuroimaging findings of 139 patients with idiopathic intracranial hypertension: A clinical retrospective experience

Abstract

DOI: 10.4328/JCAM.6066 Received: 30.10.2018 Accepted: 05.12.2018 Published Online: 06.12.2018 Printed: 01.03.2019 J Clin Anal Med 2019;10(2): 239-42 Corresponding Author: Eda Çoban, Neurology Department, Neurosurgery and Psychiatry, Bakırköy Education and Training Hospital of Neurology, İstanbul, Turkey. GSM: +905054834377 E-Mail: eda_coban@yahoo.com ORCID ID: 0000 0001 5894 7318 Abstract Aim: Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri is a challenging condition with raised intracranial pressure (ICP) in the absence of identifiable cause. Typical clinical manifestations can be a headache, tinnitus, papilledema, and decreased vision. The diagnosis is established by the Modified Dandy Criteria. Several brain Magnetic Resonance Imaging (MRI) findings have been associated with the diagnosis of IIH. The aim of this study is to determine the characteristics of IIH and establish whether there are characteristic appearances on MRI and MRV that are being routinely overlooked in our clinical practice. Material and Method: All patients with a diagnosis of IIH between January 2010 and January 2018 at Bakırköy Mental Health Education and Training Hospital of Neurology, Neurosurgery, and Psychiatry were enrolled. The diagnosis of IIH was established according to the Modified Dandy Criteria (Table 1). Only patients who had available images of MRV examination and/or MR imaging examination during the period of review were included. Electronic medical records were reviewed for clinical parameters such as symptom profile, age, gender, opening pressure at lumbar puncture and neuroimaging. Each case was reviewed independently by a neuroradiologist and a neurologist. Results: One hundred thirty-nine patients were included in the study. The patient group consisted of 114 females and 25 males, ages 17-72 years (38.13 ± 11.51). The most common symptom was a headache, which was noted in 84 %. Papilledema was found in 118 patients (86.33 %). In the neurological examination,7 patients had abducens nerve palsy (Table 2). Opening pressure on lumbar puncture was available in the hospital chart for 130 of the 139 IIH patients (93.5 %). Opening pressure ranged from 160 to 800 mm H2O (mean: 365 mm H2O; 1 standard deviation=130 mm H2O). One hundred twenty-two of 139 patients had abnormal opening pressure. Eight of the 139 patients hadnormal opening pressure (<250 mm H2O). The MRI was normal in 66 patients ( 47.5 %). The MRI disclosed flattening of the posterior eyeballs and vertical tortuosity of the orbital optic nerve in 6.5 %, optic nerve hyperintensity in 2.2 %, empty cella in 24.5 %, Chiari malformation in 4.3 %, and optic nerve hyperintensity together with empty cella in 9.4 % of patients (Table 3). There was no evidence of sinus thrombosis on the static images of the patients. Unilateral transverse sinus hypoplasia was perceived in 19.4 % of patients. Bilateral TS stenosis was perceived categorically in 20.9 % of patients with IIH. Discussion: The study detects that empty cella, optic nerve enhancement on MRI and bilateral transverse sinus stenosis on MRV are mostly seen neuroimaging findings in IIH patients. The presence of Chiari Malformation on MRI is also the supportive clue of IIH in the absence of sinus thrombosis. Conclusion: MRI is an important imaging technic to support the diagnosis of IIH. With further investigations, MRI can be enough to diagnose the disease in the future and it will also provide costeffectiveness.