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Mollan SP. Papilledema. Continuum (Minneap Minn) 2025; 31:436-462. [PMID: 40179403 DOI: 10.1212/con.0000000000001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025]
Abstract
OBJECTIVE This article describes the recognition, investigation, and management of papilledema. LATEST DEVELOPMENTS Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to the serious nature of papilledema, there is a fear of underdiagnosis and hence one of the major stumbling points is the correct identification of papilledema. While there has been a stepwise increase in the incidence and prevalence of idiopathic intracranial hypertension due to the worldwide epidemic of people living with obesity, secondary causes such as cerebral venous sinus thrombosis, intracranial masses, and infections must not be missed. Our ability to image the optic nerve has been greatly enhanced by the directed use of optical coherence tomography, with recent studies observing novel imaging findings that can help distinguish pseudopapilledema from papilledema. The structured investigation of papilledema is now routine and research into the management of CSF disorders is finding new avenues for targeted treatments. ESSENTIAL POINTS Confirmation of papilledema typically requires a thorough ocular examination including visual field testing. Ocular imaging such as color fundus photographs and optical coherence tomography are useful. Joint care between ophthalmologists and neurologists is key to treating the underlying condition and managing any visual dysfunction and headache.
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Klausner MS, Gianoli GJ, Johnson P, Mamikoglu B. The challenge of diagnosing intracranial pressure elevations as an otolaryngologist. Eur Arch Otorhinolaryngol 2025:10.1007/s00405-025-09333-9. [PMID: 40155542 DOI: 10.1007/s00405-025-09333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 03/10/2025] [Indexed: 04/01/2025]
Abstract
PURPOSE This article addresses the complex clinical scenario where patients present to otolaryngologists with symptoms typically ascribed to chronic rhinosinusitis (CRS) or migraines which may in fact stem from elevations in intracranial pressure. We aim to clarify the diagnostic challenges and emphasize the importance of considering elevated intracranial pressure (eICP) as its symptoms overlap with both CRS and migraines. METHODS This narrative review synthesizes clinical experiences and literature to discuss the differential diagnoses involving CRS, facial pain/pressure, migraines, and eICP. Key discussion points include symptomatology of eICP and its management in otolaryngological practice. RESULTS Patients presenting with symptoms of CRS or migraine may exhibit overlapping signs that makes diagnosis challenging. Patients with symptoms of facial pain and pressure, or other findings such as ear fullness, muffled hearing, and tinnitus, that do not resolve with conventional topical intranasal therapies or migraine management should be worked up for eICP. CONCLUSION The overlap in clinical presentations among patients with concern for CRS, migraines, and ICP elevations poses a diagnostic challenge. It is crucial for otolaryngologists and neurologists to collaborate closely to ensure accurate diagnoses and appropriate management. Enhanced awareness and understanding of the broader spectrum of symptoms associated with eICP can prevent misdiagnosis and promote better patient outcomes.
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Affiliation(s)
- Michelle S Klausner
- New York Medical College School of Medicine, Valhalla, NY, United States of America.
| | - Gerard J Gianoli
- The Ear and Balance Institute, 1401 Ochsner Blvd. Suite A, Covington, LA, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Patricia Johnson
- New York Medical College School of Medicine, Valhalla, NY, United States of America
- Department of Otolaryngology, Westchester Medical Center, Valhalla, NY, United States of America
| | - Bulent Mamikoglu
- Department of Otolaryngology, Westchester Medical Center, Valhalla, NY, United States of America
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Handzic A, Tao BK, O'Cearbhaill RM, Nicholson PJ, Margolin EA, Micieli JA. Assessment of Reversibility of Transverse Venous Sinus Stenosis in Patients With Papilledema. J Neuroophthalmol 2025; 45:4-9. [PMID: 38373047 DOI: 10.1097/wno.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Bilateral transverse venous sinus stenosis (TVSS) or stenosis of a dominant venous sinus has been found to be very sensitive radiological findings in patients with intracranial hypertension (IH), yet there is still an ongoing debate whether they constitute reversible or permanent phenomena. Thus, the purpose of this study was to investigate the reversibility of TVSS in patients with IH, including conservatively treated patients with signs of IH as defined by the presence of papilledema. METHODS This was a retrospective chart review of all patients diagnosed with IH between 2016 and 2022, assessed from 2 tertiary university-affiliated neuro-ophthalmology practices. Inclusion criteria were the presence of papilledema, as quantified by optical coherence tomography, and bilateral TVSS, which is considered typical of IH on neuroimaging. During follow-up, included patients must have had confirmation of papilledema resolution as well as subsequent neuroimaging after conservative treatment or cerebrospinal fluid flow diversion. Patients with dural sinus vein thrombosis or intrinsic stenosis from sinus trabeculations or significant arachnoid granulations were excluded from the study. Either CT venography or MRI/MR venography was reviewed by a fellowship-trained neuroradiologist, and the degree of stenosis was scored through the combined conduit score (CCS), as described by Farb et al. The primary outcome was to assess TVSS changes after resolution or improvement of papilledema. RESULTS From 435 patients, we identified a subset of 10 who satisfied all inclusion criteria. Our cohort comprised entirely women with a median age of 29.5 years and a median BMI of 32.5 kg/m 2 . Treatment consisted of acetazolamide in 7 patients, of which 1 had additional topiramate and 2 underwent cerebrospinal fluid flow diversion. Furthermore, 6 patients demonstrated significant weight loss during follow-up. For the primary outcome, 5 of 10 patients exhibited no appreciable TVSS change, and 5 patients demonstrated significant improvement in TVSS, of which 4 received conservative treatment only. Papilledema resolution or improvement was statistically significantly associated with increasing average CCS, TVSS diameter, and grade. CONCLUSIONS We were able to demonstrate that TVSS can be both irreversible and reversible in patients with resolved papilledema. The finding of TVSS reversibility from conservative treatment alone is novel and has important implications to optimize patient care. Future studies should work to identify factors associated with irreversible TVSS for subsequent targeted intervention and prevention.
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Affiliation(s)
- Armin Handzic
- Department of Ophthalmology and Vision Sciences (AH, EAM, JAM), Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Medicine (BKT), University of British Columbia, Vancouver, Canada; Division of Neuroradiology (RMOC, PJN), Department of Radiology, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Neurology (EAM, JAM), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Center (JAM), Toronto, Canada
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Kula AY, Polat YB, Atasoy B, Yiğit M, Kırık F, Pasin Ö, Alkan A. Non-invasive estimation of cerebrospinal fluid pressure in idiopathic intracranial hypertension: magnetic resonance imaging analysis of optic nerve and eyeball. Acta Neurol Belg 2025; 125:61-68. [PMID: 39147997 DOI: 10.1007/s13760-024-02620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/08/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE Invasive methods such as lumbar puncture and intraventricular catheters are commonly used to measure intracranial pressure (ICP). This study aims to develop quantitative and non-invasive techniques to measure ICP in patients with Idiopathic Intracranial Hypertension (IIH) using magnetic resonance imaging (MRI) findings. METHODS MRI data obtained from 50 patients with IIH and 30 age- and sex- matched controls were analyzed and optic nerve sheath diameter (ONSD), eyeball transverse diameter (ETD) and optic nerve diameter (OND) were measured. ONSD, ONSD/ETD and OND/ONSD indexes were calculated according to different ONSD measurement distances. Correlations of MRI findings with ICP were calculated. Sensitivity and specificity of all methods were analyzed. RESULTS ONSD and ONSD/ETD index at 3 mm and 10 mm behind the eyeball were significantly higher (p < 0.001) and OND/ONSD index at 3 mm behind the eyeball was significantly lower (p < 0.001) in the IIH group. The ONSD/ETD index at 3 mm had the highest area under the curve (AUC) value (0.898) with a cut-off of 0.27 mm (82% sensitivity and 91.67% specificity) for predicting high cerebrospinal fluid (CSF) pressure, followed by ONSD measurements at 3 mm (AUC = 0.886) with a cut-off of 6.17 mm (83% sensitivity and 86.67% specificity). The OND/ONSD index at 3 mm posterior to the eyeball decreased significantly as ICP increased, and the strength of the relationship was moderate (p < 0.001; r = -0.358). CONCLUSIONS ONSD and ONSD/ETD index measured on MRI sequences are potentially useful in detecting elevated ICP. The OND/ONSD index correlates with CSF pressure and these techniques may be helpful in diagnosing IIH.
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Affiliation(s)
- Aslı Yaman Kula
- Department of Neurology, Faculty of Medicine, Bezmialem Foundation University, İskenderpaşa Mahallesi, Adnan Menderes Bulvarı, Istanbul, 34093, Fatih, Turkey.
| | - Yağmur Başak Polat
- Department of Radiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Bahar Atasoy
- Department of Radiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Mehmet Yiğit
- Department of Anatomy, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Furkan Kırık
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Özge Pasin
- Department of Biostatistics, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
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Arkoudis NA, Davoutis E, Siderakis M, Papagiannopoulou G, Gouliopoulos N, Tsetsou I, Efthymiou E, Moschovaki-Zeiger O, Filippiadis D, Velonakis G. Idiopathic intracranial hypertension: Imaging and clinical fundamentals. World J Radiol 2024; 16:722-748. [PMID: 39801664 PMCID: PMC11718525 DOI: 10.4329/wjr.v16.i12.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 11/15/2024] [Accepted: 12/11/2024] [Indexed: 12/27/2024] Open
Abstract
Neuroimaging is a paramount element for the diagnosis of idiopathic intracranial hypertension, a condition characterized by signs and symptoms of raised intracranial pressure without the identification of a mass or hydrocephalus being recognized. The primary purpose of this review is to deliver an overview of the spectrum and the specific role of the various imaging findings associated with the condition while providing imaging examples and educational concepts. Clinical perspectives and insights into the disease, including treatment options, will also be discussed.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- Research Unit of Radiology and Medical Imaging, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- 2nd Department of Radiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Efstathia Davoutis
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Manos Siderakis
- Department of Radiology, Agios Savas Anticancer Hospital, Athens 11522, Greece
| | - Georgia Papagiannopoulou
- 2nd Department of Neurology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Nikolaos Gouliopoulos
- 2nd Department of Ophthalmology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Ilianna Tsetsou
- Department of Imaging and Interventional Radiology, “Sotiria” General and Chest Diseases Hospital of Athens, Athens 11527, Greece
| | - Evgenia Efthymiou
- Research Unit of Radiology and Medical Imaging, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- 2nd Department of Radiology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- 2nd Department of Radiology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Chaidari 12462, Greece
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Curry SD, Boochoon KS, Casazza GC, Surdell DL, Cramer JA. Deep learning to predict risk of lateral skull base cerebrospinal fluid leak or encephalocele. Int J Comput Assist Radiol Surg 2024; 19:2453-2461. [PMID: 39207718 DOI: 10.1007/s11548-024-03259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Skull base features, including increased foramen ovale (FO) cross-sectional area, are associated with lateral skull base spontaneous cerebrospinal fluid (sCSF) leak and encephalocele. Manual measurement requires skill in interpreting imaging studies and is time consuming. The goal of this study was to develop a fully automated deep learning method for FO segmentation and to determine the predictive value in identifying patients with sCSF leak or encephalocele. METHODS A retrospective cohort study at a tertiary care academic hospital of 34 adults with lateral skull base sCSF leak or encephalocele were compared with 815 control patients from 2013-2021. A convolutional neural network (CNN) was constructed for image segmentation of axial computed tomography (CT) studies. Predicted FO segmentations were compared to manual segmentations, and receiver operating characteristic (ROC) curves were constructed. RESULTS 295 CTs were used for training and validation of the CNN. A separate dataset of 554 control CTs was matched 5:1 on age and sex with the sCSF leak/encephalocele group. The mean Dice score was 0.81. The sCSF leak/encephalocele group had greater mean (SD) FO cross-sectional area compared to the control group, 29.0 (7.7) mm2 versus 24.3 (7.6) mm2 (P = .002, 95% confidence interval 0.02-0.08). The area under the ROC curve was 0.69. CONCLUSION CNNs can be used to segment the cross-sectional area of the FO accurately and efficiently. Used together with other predictors, this method could be used as part of a clinical tool to predict the risk of sCSF leak or encephalocele.
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Affiliation(s)
- Steven D Curry
- Department of Otolaryngology, Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE, 68198-1225, USA.
| | - Kieran S Boochoon
- Department of Otolaryngology, Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE, 68198-1225, USA
| | - Geoffrey C Casazza
- Department of Otolaryngology, Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE, 68198-1225, USA
| | - Daniel L Surdell
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA
| | - Justin A Cramer
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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Sabet SJ, Gasquet NC, Henderson AD, Carey AR. Clinical Characteristics of Idiopathic Intracranial Hypertension in Older Adults. J Neuroophthalmol 2024; 44:502-506. [PMID: 38236646 PMCID: PMC11255125 DOI: 10.1097/wno.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a condition that classically affects obese women of child-bearing age. However, it is sometimes encountered in older patients. The purpose of this study was to help clinicians better understand how this disease can present differently in these age groups. METHODS This is a retrospective chart review from a single academic center of baseline characteristics of adult patients diagnosed with IIH based on the modified Dandy criteria. The patients were divided into 2 groups: (1) those 18-44 years old and (2) those older than 45 years at diagnosis. RESULTS One hundred sixty-seven patients were identified; 135 in the younger group and 32 in the older group. The younger group had a higher rate of headaches (90% vs 63%, P = 0.0004), higher body mass index (38.9 vs 36.1, P = 0.046), higher opening pressure (38 vs 31 cm H 2 O, P = 0.005), and thicker peripapillary retinal nerve fiber layer average thickness (right eye 178 vs 131 μm, P = 0.02; left eye 184 vs 136 μm, P = 0.045). The older group had higher rates of empty sella (90% vs 62%, P = 0.0039). In addition in the younger group, there was a trend toward higher rates of pulsatile tinnitus (63% vs 45%, P = 0.08), transient visual obscurations (50% vs 32%, P = 0.07), and lower rates of spontaneous cerebrospinal fluid leak (4% vs 13%, P = 0.08). Sex, rates of obesity, other MRI findings typical of elevated intracranial pressure, frequency and Frisen grading of papilledema, and visual field loss were not statistically different between the groups. CONCLUSIONS The older age group had milder signs and symptoms of IIH and a higher prevalence of empty sella than the younger group, but otherwise had typical characteristics. These findings suggest that IIH in the older age group may represent milder chronic disease that was previously undiagnosed.
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Affiliation(s)
- Sina J. Sabet
- Neuro-Ophthalmology Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolas C. Gasquet
- Wilmer Eye Institute Biostatistics Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda D. Henderson
- Neuro-Ophthalmology Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew R. Carey
- Neuro-Ophthalmology Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chaulk AL, McCarty JL, Patel RP, Chuang AZ, Adesina OOO. Prognosticators of Optic Nerve Imaging in Malignant Pseudotumor Cerebri Syndrome. J Neuroophthalmol 2024:00041327-990000000-00737. [PMID: 39593215 DOI: 10.1097/wno.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2024]
Abstract
BACKGROUND Pseudotumor cerebri (PTC) syndrome is a disorder of increased intracranial pressure, most commonly affecting overweight women of childbearing age. Malignant PTC (MPTC) is a rare presentation that involves rapidly worsening vision, often necessitating surgical intervention to prevent permanent vision loss. The goal of this study was to determine whether radiographic findings of PTC are predictive of MPTC and the final visual outcome. METHODS Charts of patients diagnosed with PTC based on the modified Dandy criteria were reviewed. Snellen best-corrected visual acuity (BCVA), automated perimetry mean deviation (APMD), and papilledema grade were documented from the initial and final follow-up examinations. The MRI images were read by 2 neuroradiologists blinded to the clinical diagnosis, and consensus findings were obtained. The patients were classified into malignant and nonmalignant PTC groups. Malignant was defined as BCVA ≤ 20/200 or APMD ≤ -7 dB, and acute onset of symptoms. The sensitivity and specificity of each MRI finding for detecting MPTC was determined. Generalized linear model with random effect and backward model selection was performed to identify which radiographic findings were predictive of final BCVA, APMD, and papilledema grade. RESULTS Overall, 114 eyes (57 malignant/57 nonmalignant) were included. No MRI finding has both sensitivity and specificity for MPTC reaching 60%. The highest sensitivity (86%) was flattening of the posterior globes and unilateral or bilateral transverse sinus stenosis. The highest specificities were completely empty sella (86%), enhancement (84%), and diffusion restriction (81%) of the prelaminar optic nerves. The presence of vertical tortuosity of the optic nerves was predictive of better final BCVA ( P = 0.003) and better final APMD ( P = 0.011). While papilledema grade was higher in MPTC, no MRI finding was predictive of papilledema grade. CONCLUSIONS No single MRI finding has both high sensitivity and specificity for diagnosing MPTC. Vertical tortuosity of the optic nerves may be predictive of better final BCVA and APMD.
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Affiliation(s)
- Alexandria L Chaulk
- Ruiz Department of Ophthalmology and Visual Science (ALC, AZC, O-oA), McGovern Medical School at UTHealth Houston, Houston, Texas; Robert Cizik Eye Clinic (ALC, AZC, O-oA), Houston, Texas; and Texas Children's Hospital (JLM, RPP), Baylor College of Medicine, Houston, Texas
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Greenberg G, Steinberg DM, Salomon O. Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath. J Neurol Sci 2024; 466:123274. [PMID: 39433010 DOI: 10.1016/j.jns.2024.123274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/29/2024] [Accepted: 10/13/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION Our objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern. PATIENTS AND METHODS This retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data. RESULTS 90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010). CONCLUSIONS Thrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.
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Affiliation(s)
- Gahl Greenberg
- Department of Diagnostic Imaging, Neuroradiology section, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Affiliated with Tel Aviv University, Faculty of Medical and Health Sciences, Tel Aviv, Israel.
| | - David M Steinberg
- Department of Statistics and Operations Research, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ophira Salomon
- Thrombosis and Hemostasis Institute, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. Affiliated with Tel Aviv University, Faculty of Medical and Health Sciences, Tel Aviv, Israel.
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Chitalkar S, Thakor D, Sheikhy A, Cole J, Fangmeyer S, Nasri F, Ahmed A, Monfared A, Taheri MR. Geniculate ganglion diverticulum: a potential imaging marker in patients with idiopathic intracranial hypertension. Clin Imaging 2024; 115:110278. [PMID: 39303404 DOI: 10.1016/j.clinimag.2024.110278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The diagnosis of idiopathic intracranial hypertension (IIH) is often challenging in patients who do not present with classic symptoms. Brain MRI can play a pivotal role, as several imaging findings, such as an empty sella appearance (ESA), have been shown to be associated with IIH. Yet, none of the MRI signs have been shown to have a high sensitivity and specificity. In this study, we tested the hypothesis that presence of a geniculate ganglion diverticulum (GGD) is a potential imaging marker for the detection of IIH. MATERIALS AND METHODS This is an IRB-approved, single-institution, retrospective, observational study. Brain MRI examinations of patients referred to Radiology by Otology clinic over a period of 10 years were reviewed. 244 MRI exams fulfilling inclusion and exclusion criteria were independently screened for the presence of GGD and ESA by two Neuroradiology fellows. Electronic medical records (EMR) of patients in this study were reviewed for presence of clinical manifestations of IIH. Receiver operator characteristic (ROC) curves were generated to estimate the accuracy of each covariate in diagnosing IIH. The area under each ROC curve (AUC) was calculated to identify an accurate prognostic covariate. Statistical analysis was done using R programming language V 4.2.2. RESULTS GGD was identified in MRI exams of 51 patients. A 2:1 propensity score (PS) matching for age, gender, and Body Mass Index (BMI) was used to select non-GGD control group for comparison with the GGD group. There was strong agreement between the 2 reviewers (kappa = 0.81, agreement = 95 %). Twelve patients in this study were diagnosed with IIH. There was a high incidence of GGD (OR = 12.19, 95 % CI (2.56, 58.10)) and ESA (OR = 4.97, 95 % CI (1.47, 16.74)) in IIH patients. The AUC observed in GGD for predicting IIH was 0.771 (0.655-0.888), specificity = 0.709 (0.638-0.780), and sensitivity = 0.833 (0.583-1). The AUC observed for ESA in predicting IIH was 0.682 (0.532-0.831), specificity = 0.780 (0.709-0.844), and sensitivity = 0.583 (0.333-0.833). CONCLUSION GGD is potentially a novel imaging marker of IIH with sensitivity higher than and specificity comparable to that of ESA. CLINICAL RELEVANCE STATEMENT Presence of GGD should raise the possibility of IIH.
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Affiliation(s)
- Sachin Chitalkar
- Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America.
| | - Dipak Thakor
- Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America.
| | - Ali Sheikhy
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jamie Cole
- George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, United States of America
| | - Sarah Fangmeyer
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America.
| | - Fatemeh Nasri
- Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America
| | - Abdelmonem Ahmed
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America
| | - Ashkan Monfared
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America.
| | - Md Reza Taheri
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America.
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André M, El Gani N, Lescanne E, Boullaud L, Bakhos D. Outcomes at 6 months after isolated or non-isolated surgery for temporal bone cerebrospinal fluid leak in adults: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:329-334. [PMID: 39217053 DOI: 10.1016/j.anorl.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
AIM The main aim of this study was to evaluate 6-month closure success in surgery for isolated or non-isolated temporal bone osteomeningeal breach (OMB). Secondary objectives were to analyze complications of closure and correlations between success and breach, treatment and patient data. MATERIAL AND METHOD This was a single-center retrospective observational study of patients who underwent surgery for temporal bone OMB via a middle cranial fossa or transmastoid approach in a French university teaching hospital between 2007 and 2022, with follow-up of at least 6months. Patients with superior semicircular canal dehiscence were excluded. Study data comprised gender, age, body mass index, OMB etiology, mode of discovery, audiometric and radiological data, surgical technique, length of hospital stay and postoperative complications. The primary endpoint was absence of a cerebrospinal fluid leak on MRI at 6months. Fisher's exact test or Chi2 test were used for qualitative data and Student t-test for quantitative data. RESULTS The closure success rate was 87%: 81% (3 recurrences) in the middle cranial fossa group of 16 patients and 93% in the transmastoid group of 14 patients. Postoperative audiometry showed significant improvement (P=0.0016) for air conduction in the middle cranial fossa group. Five patients (17%) operated on via the middle cranial fossa approach and 1 (7%) operated on via the transmastoid approach had postoperative complications. OMB was in the tegmen mastoideum in 8 patients (29%), tegmen tympani in 7 (25%), tegmen antri in 4 (14%), tegmina antri and tympani in 3 (11%), antri and mastoideum in 1 (8%) and in the whole tegmen in 5 (18%). Eleven OMBs were lateral to the superior semicircular canal, 13 medial and 4 on either side. CONCLUSION The transmastoid approach is indicated in case of associated middle-ear procedures, patients aged over 75years or OMB lateral to the superior semicircular canal. The middle cranial fossa approach is reserved for OMB located medial to the superior semicircular canal patients under 75years of age without associated ossicular procedures. For patients with OMB medial to the superior semicircular canal who require middle-ear surgery, a combined approach can be used.
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Affiliation(s)
- M André
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - N El Gani
- Service de Neuroradiologie, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - E Lescanne
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de Médecine, Université de Tours, 10, boulevard Tonnellé, 37044 Tours, France
| | - L Boullaud
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de Médecine, Université de Tours, 10, boulevard Tonnellé, 37044 Tours, France
| | - D Bakhos
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Faculté de Médecine, Université de Tours, 10, boulevard Tonnellé, 37044 Tours, France; Inserm U1253, iBrain, Université de Tours, 10, boulevard Tonnellé, 37044 Tours, France; House Institute Foundation, 2100W 3rd Street, Suite 111, Los Angeles, CA 90057, USA
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12
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Bastani Viarsagh S, Agar A, Lawlor M, Fraser C, Golzan M. Non-invasive assessment of intracranial pressure through the eyes: current developments, limitations, and future directions. Front Neurol 2024; 15:1442821. [PMID: 39524910 PMCID: PMC11545690 DOI: 10.3389/fneur.2024.1442821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/27/2024] [Indexed: 11/16/2024] Open
Abstract
Detecting and monitoring elevated intracranial pressure (ICP) is crucial in managing various neurologic and neuro-ophthalmic conditions, where early detection is essential to prevent complications such as seizures and stroke. Although traditional methods such as lumbar puncture, intraparenchymal and intraventricular cannulation, and external ventricular drainage are effective, they are invasive and carry risks of infection and brain hemorrhage. This has prompted the development of non-invasive techniques. Given that direct, non-invasive access to the brain is limited, a significant portion of research has focused on utilizing the eyes, which uniquely provide direct access to their internal structure and offer a cost-effective tool for non-invasive ICP assessment. This review explores the existing non-invasive ocular techniques for assessing chronically elevated ICP. Additionally, to provide a comprehensive perspective on the current landscape, invasive techniques are also examined. The discussion extends to the limitations inherent to each technique and the prospective pathways for future advancements in the field.
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Affiliation(s)
| | - Ashish Agar
- Ophthalmology Department, Prince of Wales Hospital, UNSW, Darlington, NSW, Australia
| | - Mitchell Lawlor
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Clare Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Mojtaba Golzan
- Vision Science Group (Orthoptics), Faculty of Health, UTS, Sydney, NSW, Australia
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Pandit AS, China M, Jain R, Jalal AHB, Jelen M, Joshi SB, Skye C, Abdi Z, Aldabbagh Y, Alradhawi M, Banks PDW, Stasiak MK, Tan EBC, Yildirim FC, Ruffle JK, D'Antona L, Asif H, Thorne L, Watkins LD, Nachev P, Toma AK. The utility of MRI radiological biomarkers in determining intracranial pressure. Sci Rep 2024; 14:23238. [PMID: 39369053 PMCID: PMC11455934 DOI: 10.1038/s41598-024-73750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 09/20/2024] [Indexed: 10/07/2024] Open
Abstract
Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The retrospective study included 325 adult patients with suspected CSF dynamic disorders who underwent brain MRI scans within three months of elective 24-h ICP monitoring. Five MRI biomarkers were assessed: Yuh sella grade, optic nerve vertical tortuosity (VT), optic nerve sheath distension, posterior globe flattening and optic disc protrusion (ODP). The association between individual biomarkers and 24-h ICP was examined and reversibility of each following CSF diversion was assessed. Multivariate models incorporating these radiological biomarkers were utilised to predict 24-h median intracranial pressure. All five biomarkers were significantly associated with median 24-h ICP (p < 0.0001). Using a pair-wise approach, the presence of each abnormal biomarker was significantly associated with higher median 24-h ICP (p < 0.0001). On multivariate analysis, ICP was significantly and positively associated with Yuh sella grade (p < 0.0001), VT (p < 0.0001) and ODP (p = 0.003), after accounting for age and suspected diagnosis. The Bayesian multiple linear regression model predicted 24-h median ICP with a mean absolute error of 2.71 mmHg. Following CSF diversion, we found pituitary sella grade to show significant pairwise reversibility (p < 0.001). ICP was predicted with clinically useful precision utilising a compact Bayesian model, offering an easily interpretable tool using non-invasive MRI data. Brain MRI biomarkers are anticipated to play a more significant role in the screening, triaging, and referral of patients with suspected CSF dynamic disorders.
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Affiliation(s)
- Anand S Pandit
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Musa China
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Division of Medicine, University College London, UCL, London, UK
| | - Raunak Jain
- Division of Medicine, University College London, UCL, London, UK
| | - Arif H B Jalal
- Division of Medicine, University College London, UCL, London, UK
| | - Maria Jelen
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Shivani B Joshi
- Division of Medicine, University College London, UCL, London, UK
| | - Crystallynn Skye
- Division of Medicine, University College London, UCL, London, UK
| | - Zakee Abdi
- School of Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Yousif Aldabbagh
- Division of Medicine, University College London, UCL, London, UK
| | | | - Ptolemy D W Banks
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Martyna K Stasiak
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Emily B C Tan
- Division of Medicine, University College London, UCL, London, UK
| | - Fleur C Yildirim
- Department of Psychology and Language Sciences, University College London, London, UK
| | - James K Ruffle
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Linda D'Antona
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hasan Asif
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lewis Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurence D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Parashkev Nachev
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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14
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Sheibani A, Hashemi N, Beizaei B, Tavakkolizadeh N, Shoja A, Karimabadi N, Mirakhorli H, Hasanabadi P, Payandeh A, Hassannejad E. A narrative review of magnetic resonance imaging findings in pediatric idiopathic intracranial hypertension. Health Sci Rep 2024; 7:e70111. [PMID: 39381534 PMCID: PMC11458882 DOI: 10.1002/hsr2.70111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 08/06/2024] [Accepted: 09/11/2024] [Indexed: 10/10/2024] Open
Abstract
Background and Aims Idiopathic intracranial hypertension (IIH) is a rare neurological disorder in the pediatric population which is defined as an increase in intracranial pressure (ICP) without the presence of brain parenchymal lesions, hydrocephalus, or central nervous system infection. In this study, we have determined the magnetic resonance imaging (MRI) findings in IIH patients. Methods A comprehensive literature search was conducted using the electronic databases including Web of Sciences, Scopus, and Pubmed to identify suitable and relevant articles using keyword search methods. The search included keywords such as "idiopathic intracranial hypertension," "pseudotumor cerebri," "MRI," and "pediatrics." The search was limited to the available publications up to January 2024. Results MRI plays a crucial role in diagnosing IIH by excluding secondary causes and revealing neuroimaging findings associated with elevated ICP. Despite fewer studies in children compared to adults, MRI serves as a cornerstone in identifying traditional neuroradiological markers such as empty sella turcica, posterior globe flattening, optic nerve tortuosity, optic nerve sheath distension, and transverse venous sinus stenosis. Additional subtle markers include increased Meckel's cave length, cerebellar tonsillar herniation, and slit-like ventricles, although these are less reliable. Diffusion-weighted imaging does not typically show cerebral ADC value changes indicative of cerebral edema in pediatric IIH. Conclusion MRI findings provide valuable non-invasive diagnostic indicators that facilitate early detection, clinical management, and potential surgical intervention in pediatric IIH. The reliability of these MRI markers underscores their importance in clinical practice.
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Affiliation(s)
- Abdolreza Sheibani
- Department of RadiologyGolestan Hospital, Ahvaz Jundishapur University of Medical SciencesAhvazIran
| | - Narges Hashemi
- Department of PediatricsSchool of Medicine, Mashhad University of Medical SciencesMashhadIran
| | - Behnam Beizaei
- Department of RadiologyFaculty of Medicine, Mashhad University of Medical SciencesMashhadIran
| | - Nahid Tavakkolizadeh
- Department of RadiologyFaculty of Medicine, Mashhad University of Medical SciencesMashhadIran
| | - Ahmad Shoja
- Department of RadiologySchool of Medicine, Birjand University of Medical SciencesBirjandIran
| | - Neda Karimabadi
- Department of RadiologyFaculty of Medicine, Mashhad University of Medical SciencesMashhadIran
| | | | - Parsa Hasanabadi
- Student Research Committee, KurdistanUniversity of Medical SciencesSanandajIran
- Student Committee of Medical Education Development, Education Development CenterKurdistan University of Medical SciencesSanandajIran
- Medicine FacultyKurdistan University of Medical SciencesSanandajIran
| | - Asma Payandeh
- Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ehsan Hassannejad
- Department of RadiologySchool of Medicine, Birjand University of Medical SciencesBirjandIran
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15
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Knoche T, Pietrock C, Neumann K, Rossel-Zemkouo M, Danyel LA. Transorbital B-mode ultrasound for the assessment of posterior globe flattening in idiopathic intracranial hypertension: a pilot study. Ultrasound J 2024; 16:39. [PMID: 39158778 PMCID: PMC11333676 DOI: 10.1186/s13089-024-00388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Posterior globe flattening (PGF) is a specific neuroimaging sign in patients with idiopathic intracranial hypertension (IIH), but its detection is based on subjective qualitative neuroradiological assessment. This study sought to evaluate the utility of transorbital ultrasound to detect and quantify PGF in IIH patients using the Posterior Globe Angle (PGA). METHODS Consecutive IIH patients and healthy controls were enrolled in a prospective case-control study. Transorbital ultrasound was performed to assess the presence of PGF. For quantification of PGF, an angular measurement (PGA) was performed with the vertex centering the optic nerve at a predefined distance from the lamina cribrosa and angle legs tangentially aligned to the borders of the vitreous body. PGA measurements were compared between IIH patients and healthy controls. Additionally, the diagnostic accuracy of PGA measurements in detecting PGF was evaluated using ROC analysis. RESULTS Thirty-one IIH patients (37.3 ± 12.3 years, 29 female) and 28 controls (33.3 ± 11.8 years, 21 female) were compared. PGF was present in 39% of IIH patients and absent in the control group. PGA3mm measurements significantly differed between IIH and controls (116.5° ± 5.5 vs. 111.7° ± 2.9; p < 0.001). A PGA3mm cutoff of ≥ 118.5° distinguished IIH patients from controls with 100% specificity, while retaining a sensitivity of 37.5%. CONCLUSIONS Transorbital ultrasound may be applied to detect and quantify PGF in IIH patients. Prospective, multicenter studies with extended cohorts and blinded design are needed to validate these preliminary findings and confirm the diagnostic utility of transorbital ultrasound for the assessment of PGF in IIH.
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Affiliation(s)
- Theresia Knoche
- Department of Neurology, Charité Universitätsmedizin Berlin - Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Charlotte Pietrock
- Department of Neurology, Charité Universitätsmedizin Berlin - Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mirjam Rossel-Zemkouo
- Department of Ophthalmology, Charité Universitätsmedizin Berlin - Campus Virchow Klinikum, Berlin, Germany
| | - Leon Alexander Danyel
- Department of Neurology, Charité Universitätsmedizin Berlin - Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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16
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Balık AÖ, Akıncı O, Yıldız S, Hasırcı Bayır BR, Ulutaş C. Role of neuroimaging markers on predicting of idiopathic intracranial hypertension. Acta Radiol 2024; 65:999-1006. [PMID: 38870347 DOI: 10.1177/02841851241256008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND The goals of neuroimaging in idiopathic intracranial hypertension (IIH) are the exclusion of mimickers and effective management of disease. In recent studies, several imaging markers have been identified as potential predictors of IIH. PURPOSE To investigate the predictive roles of novel radiological markers as the Meckel's cave area, alongside classical radiologic markers in identifying IIH such as the empty sella. MATERIAL AND METHODS The patients were classified according to cerebrospinal fluid (CSF) opening pressure as the IIH group and control group. The observational, case-control study included 22 patients with IIH and 22 controls. Groups were compared for presence of empty sella, Meckel's cave area, fat area of posterior neck, fat thickness of scalp, presence of transverse sinus stenosis, and ophthalmic markers, such as increase of optic nerve (ON) sheath diameter. RESULTS In the IHH group, higher occurrences of increased ON sheath diameter, ON tortuosity, flattening of the scleral surface, and transverse sinus stenosis were observed (P < 0.001, P < 0.001, P = 0.046, and P = 0.021, respectively). Meckel's cave area and fat area of posterior neck were similar in both groups (P = 0.444 and P = 0.794). CONCLUSION Ophthalmic markers and transverse sinus stenosis could be utilized as radiologic features supporting early and precise diagnosis of IIH. However, enlargement of Meckel's cave area and measurements of fatty area of posterior neck are not helpful for diagnosis of IIH.
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Affiliation(s)
- Ayşe Özlem Balık
- Department of Radiology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Okan Akıncı
- Department of Radiology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Selçuk Yıldız
- Department of ENT, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Buse Rahime Hasırcı Bayır
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Can Ulutaş
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
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17
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Yoshida H, Tanaka F, So K, Kumai Y. Analysis of Magnetic Resonance Imaging in Paranasal Mucocele with Visual Disturbance. ORL J Otorhinolaryngol Relat Spec 2024; 86:132-139. [PMID: 38934175 DOI: 10.1159/000539891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Ocular imaging strategies have evolved to facilitate the diagnosis of optic neuropathy. This study aimed to evaluate the pathogenesis of visual disturbance associated with paranasal mucocele via magnetic resonance imaging (MRI). METHODS A total of 19 patients with mucocele and visual disturbance who underwent endoscopic sinus surgery, orbital MRI, and sinus computed tomography were included. The age, sex, days from onset to surgery, eye pain, and imaging findings were analyzed. The results were compared between two groups: 7 patients with preoperative visual acuity worse than 20/200 (the poor group) and 12 patients with equal or better than 20/200 (the fair group). RESULTS Imaging showed a high compression rate of the orbit in 17 (89.5%) and enlargement of the subarachnoid space around the optic nerve in 15 (78.9%) of 19 patients. Preoperative vision was significantly poor in cases with hyperintense regions in the optic nerve on T2-weighted imaging, indicating the presence of optic neuritis. No cases showed severe inflammation of the cyst or the presence of intraorbital fat tissue. CONCLUSION MRI-based diagnosis proved useful in evaluating pathological factors, such as orbital compression, ischemia, and optic neuritis, in individual cases. It can help in gaining insight into the pathogenesis and developing appropriate treatment strategies for visual disturbances associated with paranasal mucocele.
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Affiliation(s)
- Haruo Yoshida
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Fujinobu Tanaka
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Kenji So
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology - Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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18
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Jaganathan S, Baker A, Ram A, Krishnan V, Elhusseiny AM, Philips PH, Glasier CM, Jayappa S, Choudhary A, Ramakrishnaiah R. Collapse or distention of the perioptic space in children - What does it mean to pediatric radiologists? Comprehensive review of perioptic space evaluation. Clin Imaging 2024; 111:110150. [PMID: 38723403 DOI: 10.1016/j.clinimag.2024.110150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/01/2024]
Abstract
The perioptic space comprises the subarachnoid space [SAS] of the optic nerve communicating with the SAS of the central nervous system. Pressure variations in the SAS of the central nervous system can be transmitted to the optic papilla through the perioptic space. Variations in the diameter of the perioptic space serve as an important indicator for select intracranial pathologies in the pediatric population. Though the perioptic space can be evaluated using various imaging modalities, MRI is considered highly effective due to its superior soft tissue resolution. With advancement in MR imaging techniques, high-resolution images of the orbits can provide improved visualization of the perioptic space. It is imperative for the pediatric radiologist to routinely assess the perioptic space on brain and orbit MR imaging, as it can prompt exploration for additional features associated with select intracranial pathologies, thus improving diagnostic accuracy. This article reviews basic anatomy of the perioptic space, current understanding of the CSF dynamics between the perioptic space and central nervous system SAS, various imaging modalities utilized in the assessment of the perioptic space, MRI sequences and the optimal parameters of specific sequences, normal appearance of the perioptic space on MR imaging, and various common pediatric pathologies which cause alteration in the perioptic space.
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Affiliation(s)
- Sriram Jaganathan
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA.
| | - Andrew Baker
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Venkatram Krishnan
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul H Philips
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Charles M Glasier
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Sateesh Jayappa
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Arabinda Choudhary
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Raghu Ramakrishnaiah
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
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Kerscher SR, Zipfel J, Haas-Lude K, Bevot A, Schuhmann MU. Ultrasound-guided initial diagnosis and follow-up of pediatric idiopathic intracranial hypertension. Pediatr Radiol 2024; 54:1001-1011. [PMID: 38506946 PMCID: PMC11111542 DOI: 10.1007/s00247-024-05905-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension in children often presents with non-specific symptoms found in conditions such as hydrocephalus. For definite diagnosis, invasive intracranial pressure measurement is usually required. Ultrasound (US) of the optic nerve sheath diameter provides a non-invasive method to assess intracranial pressure. Transtemporal US allows imaging of the third ventricle and thus assessment for hydrocephalus. OBJECTIVE To investigate whether the combination of US optic nerve sheath and third ventricle diameter can be used as a screening tool in pediatric idiopathic intracranial hypertension to indicate elevated intracranial pressure and exclude hydrocephalus as an underlying pathology. Further, to analyze whether both parameters can be used to monitor treatment outcome. MATERIALS AND METHODS We prospectively included 36 children with idiopathic intracranial hypertension and 32 controls. Using a 12-Mhz linear transducer and a 1-4-Mhz phased-array transducer, respectively, optic nerve sheath and third ventricle diameters were determined initially and during the course of treatment. RESULTS In patients, the mean optic nerve sheath diameter was significantly larger (6.45±0.65 mm, controls: 4.96±0.32 mm) and the mean third ventricle diameter (1.69±0.65 mm, controls: 2.99±1.31 mm) was significantly smaller compared to the control group, P<0.001. Optimal cut-off values were 5.55 mm for the optic nerve sheath and 1.83 mm for the third ventricle diameter. CONCLUSIONS The combined use of US optic nerve sheath and third ventricle diameter is an ideal non-invasive screening tool in pediatric idiopathic intracranial hypertension to indicate elevated intracranial pressure while ruling out hydrocephalus. Treatment can effectively be monitored by repeated US, which also reliably indicates relapse.
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Affiliation(s)
- Susanne Regina Kerscher
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany.
| | - Julian Zipfel
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
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Manjila S, Alsalama AA, Medani K, Patel S, Prabhune A, Ramachandran SN, Mani S. Is foramen magnum decompression for acquired Chiari I malformation like putting a finger in the dyke? - A simplistic overview of artificial intelligence in assessing critical upstream and downstream etiologies. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:153-165. [PMID: 38957754 PMCID: PMC11216646 DOI: 10.4103/jcvjs.jcvjs_160_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/09/2024] [Indexed: 07/04/2024] Open
Abstract
Background Missed diagnosis of evolving or coexisting idiopathic (IIH) and spontaneous intracranial hypotension (SIH) is often the reason for persistent or worsening symptoms after foramen magnum decompression for Chiari malformation (CM) I. We explore the role of artificial intelligence (AI)/convolutional neural networks (CNN) in Chiari I malformation in a combinatorial role for the first time in literature, exploring both upstream and downstream magnetic resonance findings as initial screening profilers in CM-1. We have also put together a review of all existing subtypes of CM and discuss the role of upright (gravity-aided) magnetic resonance imaging (MRI) in evaluating equivocal tonsillar descent on a lying-down MRI. We have formulated a workflow algorithm MaChiP 1.0 (Manjila Chiari Protocol 1.0) using upstream and downstream profilers, that cause de novo or worsening Chiari I malformation, which we plan to implement using AI. Materials and Methods The PRISMA guidelines were used for "CM and machine learning and CNN" on PubMed database articles, and four articles specific to the topic were encountered. The radiologic criteria for IIH and SIH were applied from neurosurgical literature, and they were applied between primary and secondary (acquired) Chiari I malformations. An upstream etiology such as IIH or SIH and an isolated downstream etiology in the spine were characterized using the existing body of literature. We propose the utility of using four selected criteria for IIH and SIH each, over MRI T2 images of the brain and spine, predominantly sagittal sequences in upstream etiology in the brain and multiplanar MRI in spinal lesions. Results Using MaChiP 1.0 (patent/ copyright pending) concepts, we have proposed the upstream and downstream profilers implicated in progressive Chiari I malformation. The upstream profilers included findings of brain sagging, slope of the third ventricular floor, pontomesencephalic angle, mamillopontine distance, lateral ventricular angle, internal cerebral vein-vein of Galen angle, and displacement of iter, clivus length, tonsillar descent, etc., suggestive of SIH. The IIH features noted in upstream pathologies were posterior flattening of globe of the eye, partial empty sella, optic nerve sheath distortion, and optic nerve tortuosity in MRI. The downstream etiologies involved spinal cerebrospinal fluid (CSF) leak from dural tear, meningeal diverticula, CSF-venous fistulae, etc. Conclusion AI would help offer predictive analysis along the spectrum of upstream and downstream etiologies, ensuring safety and efficacy in treating secondary (acquired) Chiari I malformation, especially with coexisting IIH and SIH. The MaChiP 1.0 algorithm can help document worsening of a previously diagnosed CM-1 and find the exact etiology of a secondary CM-I. However, the role of posterior fossa morphometry and cine-flow MRI data for intracranial CSF flow dynamics, along with advanced spinal CSF studies using dynamic myelo-CT scanning in the formation of secondary CM-I is still being evaluated.
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Affiliation(s)
- Sunil Manjila
- Department of Neurosurgery, Insight Institute of Neurosurgery and Neuroscience, Flint, MI, USA
| | | | - Khalid Medani
- Department of Occupational Medicine, Kaiser Permanente, Los Angeles, CA
| | - Shlok Patel
- Department of Orthopedic Surgery, BJ Medical College, Ahmedabad, Gujarat, India
| | - Anagha Prabhune
- Department of Neurosurgery, Sahyadri Medical Center, Pune, Maharashtra, India
| | | | - Sudhan Mani
- Department of Neurosurgery, Insight Institute of Neurosurgery and Neuroscience, Flint, MI, USA
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Prabhat N, Kaur K, Takkar A, Ahuja C, Katoch D, Goyal M, Dutta P, Bhansali A, Lal V. Pituitary Dysfunction in Idiopathic Intracranial Hypertension: An Analysis of 80 Patients. Can J Neurol Sci 2024; 51:265-271. [PMID: 37014102 DOI: 10.1017/cjn.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Empty sella is a commonly described imaging entity in patients with idiopathic intracranial hypertension (IIH). Though menstrual and hormonal disturbances have been associated with IIH, available literature lacks systematic analysis of pituitary hormonal disturbances in IIH. More so, the contribution of empty sella in causing pituitary hormonal abnormalities in patients of IIH has not been described. We carried out this study to systematically assess the pituitary hormonal abnormalities in patients with IIH and its relation to empty sella. METHODS Eighty treatment naïve patients of IIH were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging and pituitary hormonal profile were done in all patients. RESULTS Partial empty sella was seen in 55 patients (68.8%). Hormonal abnormalities were detected in 30 patients (37.5%), reduced cortisol levels in 20%, raised prolactin levels in 13.8%, low thyroid-stimulating hormone (TSH) levels in 3.8%, hypogonadism in 1.25%, and elevated levels of gonadotropins were found in 6.25% of participants. Hormonal disturbances were independent and were not associated with the presence of empty sella (p = 0.493). CONCLUSION Hormonal abnormalities were observed in 37.5% patients with IIH. These abnormalities did not correlate with the presence or absence of empty sella. Pituitary dysfunction appears to be subclinical in IIH and responds to intracranial pressure reduction, not requiring specific hormonal therapies.
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Affiliation(s)
- Nandita Prabhat
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Kirandeep Kaur
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Chirag Ahuja
- Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manoj Goyal
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
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Kobrow R, Gross S, Fleischmann R, Baldauf J, Langner S, Strauss S. Normative body mass-adjusted reference ranges of magnetic resonance imaging signs commonly used in diagnosing idiopathic intracranial hypertension in a healthy standard population. Sci Rep 2024; 14:4492. [PMID: 38396059 PMCID: PMC10891171 DOI: 10.1038/s41598-024-54975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
Patients with chronic daily headaches (CDH) are often a diagnostic challenge and frequently undergo neuroimaging. One common underlying cause of CDH is idiopathic intracranial hypertension (IIH). However, certain neuroimaging abnormalities that suggest IIH, such as optic nerve sheath diameters (ONSD), pituitary gland height, and venous sinus diameter, require interpretation due to the absence of established normative values. Notably, intracranial pressure is known to varies with age, sex and weight, further complicating the determination of objectively abnormal findings within a specific patient group. This study aims to assist clinical neuroradiologists in differentiating neuroimaging results in CDH by providing weight-adjusted normative values for imaging characteristics of IIH. In addition to age and BMI we here assessed 1924 population-based T1-weighted MRI datasets of healthy participants for relevant MRI aspects of IIH. Association to BMI was analyzed using linear/logistic regression controlled for age and stratified for sex. ONSD was 4.3 mm [2.8; 5.9]/4.6 mm [3.6; 5.7] and diameter of transverse sinus was 4.67 mm [1.6; 6.5]/4.45 mm [3.0; 7.9]. Height of pituitary gland was 5.1 mm [2.2;8.1]/4.6 mm [1.9;7.1] for female and male respectively. Values generally varied with BMI with regression slopes spanning 0.0001 to 0.05 and were therefor presented as normative values stratified by BMI. Protrusion of ocular papilla, empty sella and transverse sinus occlusion were rare in total. Our data show an association between BMI and commonly used MRI features for diagnosing IIH. We provide categorized normative BMI values for ONSD, pituitary gland height, and transverse sinus diameter. This distinction helps objectively identify potential IIH indicators compared to regular population norms, enhancing diagnostic accuracy for suspected IIH patients. Notably, optic nerve head protrusion, empty sella, and transverse sinus occlusion are rare in healthy individuals, solidifying their importance as imaging markers regardless of BMI.
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Affiliation(s)
- Rike Kobrow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Gross
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany
| | - Jörg Baldauf
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Sönke Langner
- Department of Neuroradiology, University Hospital Rostock, Rostock, Germany
| | - Sebastian Strauss
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Str. 1, 17475, Greifswald, Germany.
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Hurel C, Favier V, de Bonnecaze G, de Gabory L, Patsoura S, Molinier-Blossier S, Carrière M, Daubé P, Dufour X, Fieux M, Carsuzaa F. Transverse Venous Sinus Stenosis in Patients With Nasal Cerebrospinal Fluid Leak and Idiopathic Intracranial Hypertension. Otolaryngol Head Neck Surg 2023; 169:1647-1653. [PMID: 37435619 DOI: 10.1002/ohn.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/29/2023] [Accepted: 05/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Spontaneous nasal cerebrospinal fluid (CSF) leaks are frequently linked to idiopathic intracranial hypertension (IIH). The objectives of our study were: (1) to determine the rate of transverse venous sinus stenosis (TVSS) in patients with spontaneous nasal CSF leak and in patients with IIH without CSF (controls), and (2) to study the correlation between spontaneous nasal CSF leak and brain imaging features. STUDY DESIGN A multicenter retrospective case-control study. SETTING Six French tertiary hospitals. METHODS Patients with spontaneous nasal CSF leaks and patients with IIH without nasal CSF leaks (controls) were included. The transverse venous sinus patency was analyzed by magnetic resonance imaging to identify possible stenosis or hypoplasia. RESULTS Thirty-two patients with spontaneous nasal CSF leaks and 32 controls were included. TVSS was significantly more frequent in patients with spontaneous nasal CSF leaks than in controls (p = .029). Univariate analysis indicated that TVSS (odds ratio, OR: 4.2; 95% confidence interval, CI [1.352-14.915]; p = .017) and arachnoid granulations (OR: 3; 95% CI [1.065-8.994]; p = .042) were risk factors for spontaneous nasal CSF leak. In multivariate analysis, TVSS and arachnoid granulations were independent risk factors of nasal CSF leak (OR: 5.577, 95% CI [1.485-25.837], p = .016; and OR: 4.35, 95% CI [1.234-17.756], p = .029, respectively). CONCLUSION This multicenter case-control study shows that TVSS is an independent risk factor for CSF leak in patients with IIH. Stenosis management by interventional radiology may be proposed postoperatively to increase the success of IIH surgical treatment or preoperatively to reduce the need for surgery.
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Affiliation(s)
- Charles Hurel
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Valentin Favier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Toulouse, Toulouse, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sophia Patsoura
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | | | - Mathilde Carrière
- Department of Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Daubé
- Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Maxime Fieux
- Serviced'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université de Lyon, Université Lyon 1, Pierre Bénite, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
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Ma Z, Jiang H, Wang J. Enhancement of optic nerve sheath on MRI in idiopathic intracranial hypertension(IIH). Clin Neurol Neurosurg 2023; 231:107778. [PMID: 37348315 DOI: 10.1016/j.clineuro.2023.107778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Optic nerve sheath(ONS) enhancement in idiopathic intracranial hypertension (IIH) patients has been reported in recent years. In this retrospective observation, we analyzed the clinical characteristics of IIH patients with enhancement of ONS. METHODS Eighty-two patients with clinically diagnosed IIH from January 2017 to December 2019 were under observation. Then, based on the presence of contrast-enhancement (CE) in ONS on orbital magnetic resonance image (MRI), the IIH patients were divided into CE-ONS group and no-CE(NCE)-ONS group. Six months follow-up information was also included in the observation study. By comparing clinical data of the two groups of IIH patients, we tried to evaluate whether there is clinical heterogeneity in CE-ONS patients. RESULT 12 patients were included in CE-ONS group, 10 females and 2 males. 70 patients were included in NCE-ONS group, 56 women and 14 men. We found that patients with CE-ONS had a longer course of disease (median disease duration before diagnosis, 5 months vs. 3months, P<0.01) and more likely had the sign of distension of the perioptic subarachnoid space (DPSS) (58.33 % vs. 24.29 %, P = 0.034). But no significant differences were found in demographic characteristics, clinical symptoms, degree of visual impairment, papilledema, opening pressure(OP) on lumbar puncture and clinical outcomes. CONCLUSION As a rare sign on MRI, ONS enhancement can occur in patients with IIH. IIH patients with CE-ONS may have a longer course of disease and more prone to DPSS, but there is no significant difference in clinical manifestations, OP, and clinical outcomes compared with IIH patients without CE-ONS.
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Affiliation(s)
- Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hanqiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Raffa A, Raffa L, Kamal Y, Hassan T, Alaidarous K, Osaylan M, Almarzouki N. Pediatric optic nerve and globe measurements on magnetic resonance imaging: establishing norms for children. Acta Radiol 2023; 64:2162-2169. [PMID: 37097831 DOI: 10.1177/02841851231169176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND Normal optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) may be beneficial for describing optic nerve pathway abnormality reflecting increased intracranial pressure. Nonetheless, magnetic resonance imaging (MRI) measurement of the normal ONSD range and its associations with clinical factors and eyeball transverse diameter (ETD) are not well established in children. PURPOSE To establish normal OND, ONSD, ETD, and OND/ONSD and ONSD/ETD measurements in children and their associations with age and sex. MATERIAL AND METHODS We evaluated and analyzed 336 brain MRI studies of children aged 0.5 months to 18 years. We measured a total of 672 optic nerves. The OND and ONSD were measured 1 cm anterior to the optic foramina and 3 mm behind the optic disc on an axial T2 sequence. RESULTS The mean OND 3 mm and 1 cm, ONSD 3 mm and 1 cm, and ETD were 0.23 ± 0.05 mm and 0.16 ± 0.04 mm, 0.53 ± 0.08 mm and 0.38 ± 0.06 mm, and 2.3 ± 0.13, respectively. Only ONSD 1 cm was independent of age (P = 0.247). ONSD 3 mm and ETD were significantly wider in boys compared to girls and significantly influenced by age (both P < 0.001). Age at scan and ETD were significantly correlated (P < 0.001). CONCLUSION We established MRI-based OND, ONSD, ETD, and ONSD/ETD and OND/ONSD ratio normative values in children, which can be helpful in pediatric populations with disease.
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Affiliation(s)
- Anas Raffa
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Lina Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yumna Kamal
- Department of Ophthalmology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Tasneem Hassan
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Khadija Alaidarous
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Majed Osaylan
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nawaf Almarzouki
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Schuchardt F, Demerath T, Lützen N, Elsheikh S, Lagrèze W, Reich M, Küchlin S, Urbach H, Meckel S, Harloff A. Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis. Neuroradiology 2023; 65:463-477. [PMID: 36445465 DOI: 10.1007/s00234-022-03091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intracranial hypertension (IH) can complicate cerebral venous thrombosis (CVT), potentially causing permanent visual loss. Current knowledge on risk factors for the development of IH following CVT is scarce. We applied a compound classifier (CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI) as a surrogate for IH and studied the predictive value of thrombus location, the number of thrombosed segments, and thrombus volume. METHODS We prospectively included 26 patients with acute CVT and complete MRI data. IH was defined by CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI. Using high-resolution contrast-enhanced venography, we determined the thrombus location, number of thrombosed segments, and thrombus volume. We analyzed their association with IH by logistic regression, their predictive power by the area under the receiver operating characteristic curve, and their association with CSF opening pressure by linear regression. RESULTS IH occurred in 46% of CVT patients and was associated with higher thrombus volume (AUC 0.759, p = 0.025) and superior sagittal sinus thrombosis both alone (OR 2.086, p = 0.049) and combined with transverse sinus thrombosis (OR 2.014, p = 0.028). Effects in patients presenting CSF opening pressure > 25 cm H2O and the compound classifier were consistent. Thrombus volume > 4 ml was the single most important predictor of higher CSF opening pressure (ß = 0.566, p = 0.035), increasing IH risk. CONCLUSION Larger thrombus volume, dominant transverse sinus occlusion, and extensive superior sagittal combined with transverse sinus thrombosis were associated with IH. Thrombus volumetry might identify patients at risk for IH and direct further clinical evaluation.
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Affiliation(s)
- Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Lützen
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Elsheikh
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - W Lagrèze
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Küchlin
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Meckel
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Diagnostic and Interventional Neuroradiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - A Harloff
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
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Korsbæk JJ, Jensen RH, Høgedal L, Molander LD, Hagen SM, Beier D. Diagnosis of idiopathic intracranial hypertension: A proposal for evidence-based diagnostic criteria. Cephalalgia 2023; 43:3331024231152795. [PMID: 36786317 DOI: 10.1177/03331024231152795] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Based on expert opinion, abducens nerve palsy and a neuroimaging criterion (≥3 neuroimaging signs suggestive of elevated intracranial pressure) were added to the diagnostic criteria for idiopathic intracranial hypertension. Our objective was to validate this. METHODS This prospective study included patients with new-onset idiopathic intracranial hypertension for a standardized work-up: interview, neuro-ophthalmological exam, lumbar puncture, neuroimaging. Neuroimaging was evaluated by a blinded neuroradiologist. RESULTS We included 157 patients classified as idiopathic intracranial hypertension (56.7%), probable idiopathic intracranial hypertension (1.9%), idiopathic intracranial hypertension without papilledema (idiopathic intracranial hypertension-without papill edema; 0%), suggested idiopathic intracranial hypertension-without papill edema (4.5%), or non-idiopathic intracranial hypertension (36.9%). Moderate suprasellar herniation was more common in idiopathic intracranial hypertension than non-idiopathic intracranial hypertension (71.4% versus 47.4%, p < 0.01), as was perioptic nerve sheath distension (69.8% versus 29.3%, p < 0.001), flattening of the globe (67.1% versus 11.1%, p < 0.001) and transverse sinus stenosis (60.2% versus 18.9%, p < 0.001). Abducens nerve palsy was of no diagnostic significance. Sensitivity of ≥3 neuroimaging signs was 59.5% and specificity was 93.5%. CONCLUSION Moderate suprasellar herniation, distension of the perioptic nerve sheath, flattening of the globe and transverse sinus stenosis were associated with idiopathic intracranial hypertension. We propose that idiopathic intracranial hypertension can be defined by two out of three objective findings (papilledema, opening pressure ≥25 cm cerebrospinal fluid and ≥3 neuroimaging signs).
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Affiliation(s)
- Johanne Juhl Korsbæk
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark
| | - Lisbeth Høgedal
- Department of Radiology, Odense University Hospital, Denmark
| | | | - Snorre Malm Hagen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
| | - Dagmar Beier
- Department of Neurology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Denmark
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Presumptive Idiopathic Intracranial Hypertension Based on Neuroimaging Findings: A Referral Pattern Study. J Neuroophthalmol 2023; 43:55-62. [PMID: 36166790 DOI: 10.1097/wno.0000000000001660] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiologic findings of intracranial hypertension (RAD-IH) are common in idiopathic intracranial hypertension (IIH) patients. Paralleling the increasing rates of obesity, the burden of IIH is growing. Urgent neuro-ophthalmology consultations for possible IIH in patients with incidentally detected RAD-IH are increasing, with many patients receiving unnecessary lumbar punctures (LPs) and treatments. This retrospective observational study aimed to determine the prevalence of neuro-ophthalmology consultations for RAD-IH, rate of funduscopic examination by referring providers, prevalence of papilledema, outcomes after neuro-ophthalmic evaluation, and rates of misdiagnosis. METHODS Records of 1,262 consecutive new patients seen in one neuro-ophthalmology clinic from January 2019 to January 2020 were reviewed. We identified patients who were: 1) referred with concern for IIH because of findings of RAD-IH; 2) referred for "papilledema"; 3) referred with a diagnosis of IIH; and 4) referred for spontaneous cranial cerebrospinal fluid (CSF) leaks. In addition to basic demographic profiles for all groups, detailed information was collected for patients referred solely for RAD-IH, including referral patterns, prior history of IIH, previous LPs, prior medical or surgical treatment(s), risk factors for increased intracranial pressure (ICP), presenting symptoms, radiologic features observed on neuroimaging, and final disposition. When available, the neuroimaging was reviewed by an expert neuroradiologist. RESULTS Of 1,262 consecutive new patients, 66 (5%) were referred specifically for RAD-IH; most referrals came from neurologists (58%); 8/66 (12%) patients had papilledema; 16/66 (24%) patients had prior LP and 13/66 (20%) were already treated based on MRI findings; and 22/66 (33%) patients had ≤2 RAD-IH. Only 34/66 (52%) of patients referred for RAD-IH had prior funduscopic examinations. We confirmed papilledema in 26/82 (32%) patients referred for "papilledema." Only 29/83 (35%) patients referred with a diagnosis of IIH had active papilledema, and 3/16 (19%) patients with spontaneous CSF leaks had papilledema. In total, 247/1,262 (20%) new patients were referred to our clinic over 1 year with concern for IIH, among whom only 66 (27%) were confirmed to have active IIH with papilledema. CONCLUSIONS One in 5 new patient referrals seen in our neuro-ophthalmology clinic were referred because of concern for increased ICP, but only 1/4 had active papilledema. Most patients referred for isolated RAD-IH do not have papilledema, many having undergone unnecessary LPs and treatments. The burden of these "rule-out IIH" consultations is overwhelming and will only continue to increase with the concurrent rise of obesity and IIH, straining the already limited neuro-ophthalmologic resources available in the US.
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Asnafi S, Chen BS, Biousse V, Newman NJ, Saindane AM. Intracranial computed tomography histogram analysis detects changes in the setting of elevated intracranial pressure and normal imaging. Neuroradiol J 2022; 35:718-723. [PMID: 35506947 PMCID: PMC9626849 DOI: 10.1177/19714009221096832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with idiopathic intracranial hypertension (IIH) have elevated intracranial pressure (ICP) of unclear etiology. This study evaluated the ability of quantitative intracranial Hounsfield unit (HU) histogram analysis to detect pathophysiological changes from elevated ICP in the setting of a normal head CT. METHODS Retrospective analysis of non-contrast-enhanced head CT images of IIH patients and matched controls. Following skull stripping, total intracranial CT voxels within the range of 0-70 HU were divided into seven 10 HU bins. A measurement of total intracranial HU was also calculated for each patient. Imaging studies for IIH patients were reviewed for features of IIH including transverse sinus stenosis (TSS). Histogram measures were compared between IIH and control groups and correlated with imaging and clinical data. RESULTS Fourteen IIH patients with CSF opening pressure ≥25 cm water, and 31 age-, sex-, and ethnicity-matched controls were included. Compared to controls, IIH patients had a significantly greater proportion of voxels in the 40-50, 50-60, and 60-70 HU bins (p = 0.003, 0.001, and 0.003, respectively) but similar proportion in the 0-10 HU range. Severity of TSS significantly correlated with total intracranial HU measures. 50-60 HU and 60-70 HU bins demonstrated high AUCs of 0.81 and 0.80, respectively, in differentiating IIH from normal status. CONCLUSION Idiopathic intracranial hypertension patients have a greater proportion of high intracranial HU voxels representing blood volume, which may be explained by TSS causing venous congestion. The pattern provides further insights into the pathophysiology of IIH and may be useful for detecting elevated ICP in the setting of normal head CT imaging.
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Affiliation(s)
- Solmaz Asnafi
- Department of Radiology and Imaging
Sciences, Emory University School of
Medicine, Atlanta, GA, USA
| | - Benson S Chen
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of
Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of
Medicine, Atlanta, GA, USA
| | - Amit M Saindane
- Department of Radiology and Imaging
Sciences, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of
Medicine, Atlanta, GA, USA
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Cogswell PM, Murphy MC, Madhavan AA, Bhatti MT, Cutsforth-Gregory JK, Senjem ML, Huston J, Chen JJ. Features of Idiopathic Intracranial Hypertension on MRI With MR Elastography: Prospective Comparison With Control Individuals and Assessment of Postintervention Changes. AJR Am J Roentgenol 2022; 219:940-951. [PMID: 35822642 PMCID: PMC10481645 DOI: 10.2214/ajr.22.27904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Understanding of dynamic changes of MRI findings in response to intracranial pressure (ICP) changes in idiopathic intracranial hypertension (IIH) is limited. Brain stiffness, as assessed by MR elastography (MRE), may reflect changes in ICP. OBJECTIVE. The purpose of this study was to compare pituitary height, ventricular size, and brain stiffness between patients with IIH and control individuals and to evaluate for changes in these findings in patients with IIH after interventions to reduce ICP. METHODS. This prospective study included 30 patients (28 women, two men; median age, 29.9 years) with IIH and papilledema and 21 control individuals (21 women, 0 men; median age, 29.1 years), recruited from January 2017 to July 2019. All participants underwent 3-T brain MRI with MRE; patients with IIH underwent additional MRI examinations with MRE after acute intervention (lumbar puncture with normal closing pressure; n = 11) and/or chronic intervention (medical management or venous sinus stenting with resolution or substantial reduction in papilledema; n = 12). Pituitary height was measured on sagittal MP-RAGE images. Ventricular volumes were estimated using unified segmentation, and postintervention changes were assessed by tensor-based morphometry. Stiffness pattern score and regional stiffness values were estimated from MRE. RESULTS. In patients with IIH, median pituitary height was smaller than in control individuals (3.1 vs 4.9 mm, p < .001) and was increased after chronic (4.0 mm, p = .05), but not acute (2.3 mm, p = .50), intervention. Ventricular volume was not different between patients with IIH and control individuals (p = .33) and did not change after acute (p = .83) or chronic (p = .97) intervention. In patients with IIH, median stiffness pattern score was greater than in control individuals (0.25 vs 0.15, p < .001) and decreased after chronic (0.23, p = .11) but not acute (0.25, p = .49) intervention. Median occipital lobe stiffness was 3.08 kPa in patients with IIH versus 2.94 kPa in control individuals (p = .07) and did not change after acute (3.24 kPa, p = .73) or chronic (3.10 kPa, p = .83) intervention. CONCLUSION. IIH is associated with a small pituitary and increased brain stiffness pattern score; both findings may respond to chronic interventions to lower ICP. CLINICAL IMPACT. The "partially empty sella" sign and brain stiffness pattern score may serve as dynamic markers of ICP in IIH.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Matthew C Murphy
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - M Tariq Bhatti
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Mraja SN, Akdogan O, Mraja HM, Emre U, Karagöz Y. Evaluation of Magnetic Resonance Findings of Circumventricular Organs in Idiopathic Intracranial Hypertension Patients. Cureus 2022; 14:e31795. [DOI: 10.7759/cureus.31795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/23/2022] Open
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Morello A, Bianconi A, Cogoni M, Borgarello S, Garbossa D, Micon BM. Bilateral idiopathic optic nerve sheath meningocele: A case report and literature review. J Neurosci Rural Pract 2022; 13:781-784. [PMID: 36743743 PMCID: PMC9894007 DOI: 10.25259/jnrp_5_2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
Optic nerve (ON) sheath meningocele is an enlargement of the ON sheath, consisting in a cerebrospinal fluid collection along the perineural space of the optic nerve. It should be considered primary when it is not associated with orbital-cerebral neoplasm or with cranio-orbital junction malformations. Here, we report a case of bilateral primary idiopathic ON meningocele with gradual vision loss, treated with acetazolamide, which showed a maintained visual recovery and partial improvement during a 6-month follow-up period. The literature review retrieved eight cases of primary idiopathic ON sheath meningocele: ON sheath fenestration is considered in patients with progressive and severe vision loss, otherwise, acetazolamide treatment is indicated with good results on symptoms control, as confirmed in our case report.
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Affiliation(s)
- Alberto Morello
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Bianconi
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | | | - Diego Garbossa
- Department of Neuroscience, University of Turin, Turin, Italy
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Kuzan BN, Ilgın C, Kuzan TY, Dericioğlu V, Kahraman-Koytak P, Uluç K, Çimşit NÇ. Accuracy and reliability of magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension. Eur J Radiol 2022; 155:110491. [PMID: 36007323 DOI: 10.1016/j.ejrad.2022.110491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the diagnostic utility of brain magnetic resonance imaging (MRI) findings in patients with idiopathic intracranial hypertension (IIH) and to investigate the significance of evaluating radiological findings together with neurological and ophthalmological data in the diagnosis of IIH. MATERIALS AND METHODS All consecutive patients diagnosed with IIH in our tertiary neuro-ophthalmology center between January 1, 2018 and March 15, 2020, were included in the study. The clinical, radiological, and ophthalmological findings of IIH patients were compared with the control group with similar demographic characteristics. RESULTS A total of 98 patients, 49 cases and 49 controls, were included in the study. Lateral ventricular index had the highest area under the curve (AUC) value (0.945) for prediction of disease group followed by sella height category (AUC = 0.915) and optic nerve tortuosity (AUC = 0.855) According to the multivariate model we developed, caudate index (OR = 0.572, 95% CI 0.329-0.996), lateral ventricle index (OR = 3.969, 95% CI 1.851-8.509) and bilateral optic nerve tortuosity (OR = 22,784, 95% CI 2.432-213.450) were significant predictors for disease group. CONCLUSION Tortuosity in the optic nerve, lateral ventricular index and caudate index can be used as MRI parameters supporting the diagnosis of IIH in clinically suspicious cases. A holistic approach to the clinical and radiological findings of the cases in the diagnosis of IIH can prevent overdiagnosis and enable early correct diagnosis.
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Affiliation(s)
- Beyza Nur Kuzan
- Department of Radiology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey.
| | - Can Ilgın
- Department of Public Health, School of Medicine, Marmara University, Istanbul, Turkey.
| | - Taha Yusuf Kuzan
- Department of Radiology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
| | - Volkan Dericioğlu
- Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey.
| | | | - Kayıhan Uluç
- Department of Neurology, School of Medicine, Marmara University, Istanbul, Turkey.
| | - Nuri Çagatay Çimşit
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey.
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Sarrami AH, Bass DI, Rutman AM, Alexander MD, Aksakal M, Zhu C, Levitt MR, Mossa-Basha M. Idiopathic intracranial hypertension imaging approaches and the implications in patient management. Br J Radiol 2022; 95:20220136. [PMID: 35522777 PMCID: PMC10162046 DOI: 10.1259/bjr.20220136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) represents a clinical disease entity without a clear etiology, that if left untreated, can result in severe outcomes, including permanent vision loss. For this reason, early diagnosis and treatment is necessary. Historically, the role of cross-sectional imaging has been to rule out secondary or emergent causes of increased intracranial pressure, including tumor, infection, hydrocephalus, or venous thrombosis. MRI and MRV, however, can serve as valuable imaging tools to not only rule out causes for secondary intracranial hypertension but can also detect indirect signs of IIH resultant from increased intracranial pressure, and demonstrate potentially treatable sinus venous stenosis. Digital subtraction venographic imaging also plays a central role in both diagnosis and treatment, providing enhanced anatomic delineation and temporal flow evaluation, quantitative assessment of the pressure gradient across a venous stenosis, treatment guidance, and immediate opportunity for endovascular therapy. In this review, we discuss the multiple modalities for imaging IIH, their limitations, and their contributions to the management of IIH.
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Affiliation(s)
- Amir Hossein Sarrami
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - David I. Bass
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Matthew D Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Mehmet Aksakal
- Department of Radiology, University of Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, United States
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35
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Expansion of the Foramen Ovale in Patients With Cerebrospinal Fluid Leak or Encephalocele. Otol Neurotol 2022; 43:845-851. [PMID: 35878643 DOI: 10.1097/mao.0000000000003583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Spontaneous cerebrospinal fluid (CSF) leaks are associated with elevated intracranial pressure and idiopathic intracranial hypertension (IIH). Skull base erosion and widening of the foramen ovale have been reported in patients with IIH. This study sought to investigate changes in the size of the foramen ovale and foramen spinosum in patients with IIH, spontaneous CSF leak, and encephalocele. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic medical center. PATIENTS Adult patients treated from 2014 to 2018 with computed tomographic imaging of the head and who were diagnosed with IIH, encephalocele, or CSF leak. INTERVENTION Two blinded observers measured the long and short axes of the foramen ovale and foramen spinosum on axial computed tomographic images. Measurements were used to calculate the approximate elliptical cross-sectional area of the foramina. MAIN OUTCOME MEASURES Length, width, and area of the foramen ovale and foramen spinosum. RESULTS A total of 264 patients were identified meeting the inclusion criteria and were placed into three groups. There were 170 patients with IIH, 48 with spontaneous CSF leak or encephalocele (CSF/E group), and 46 with traumatic or iatrogenic CSF leak (control group). Mean foramen ovale short axis (4.85 ± 1.00 mm) and cross-sectional area (30.17 ± 9.25 mm2) in the CSF/E group were significantly increased compared with measurements in patients with IIH or the control groups. Foramen ovale size was positively correlated with age in the CSF/E group. No significant difference in foramen spinosum size was found. CONCLUSION Skull base defect resulting in spontaneous CSF leak or encephalocele is associated with enlargement of the foramen ovale on axial computed tomography.
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Sarigecili E, Bilen S, Gokay SS, Ucar HKOC, Dilek O. Optic nerve ultrasonography in the evaluation of the relationship between arachnoid cyst and headache. Childs Nerv Syst 2022; 38:1573-1579. [PMID: 35460353 DOI: 10.1007/s00381-022-05535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
Abstract
AIM This study is aimed to show the difference between optic nerve sheath diameter (ONSD) values in migraine patients with and without arachnoid cysts from migraine patients and control groups, and to evaluate the relationship with the arachnoid cyst size on magnetic resonance imaging (MRI) and their clinical severity. METHODS This cross-sectional study included pediatric patients who were previously diagnosed with migraine and the control group. The patients consist of 3 groups. The first group was 24 patients with arachnoid cysts on brain magnetic resonance imaging (MRI) who met the diagnostic criteria for migraine (group 1); the second group was 20 patients with only headache without arachnoid cysts or other findings on brain magnetic resonance imaging (MRI) (group 2); the third group was completely healthy 20 control group. Demographic data of the patients, the onset of headache time, clinical severity, electroencephalography (EEG) findings, optic nerve sheath diameter (ONSD) measurements by ultrasonography, and the volume of arachnoid cyst on brain MRI were determined and compared. RESULTS The optic nerve sheath diameter (ONSD) value was the highest in group 1 and the lowest in the control group (p: 0.001). The clinical severity was statistically different between the groups (p: 0.038). Accordingly, the majority of the clinical severity of group 1 was determined in grades 3 and 4. A weak positive correlation was found between the arachnoid cyst size on MRI and the ONSD measurement (r = 0.410, p = 0.047). The ONSD value statistically significantly increased with clinical severity in group 1 (p: 0.003). CONCLUSION The reliability of the optic nerve sheath diameter (ONSD) measurements in determining the increase of the intracranial pressure was shown in previous studies. This is the first study in the literature presenting that the intracranial pressure effects of arachnoid cysts can be demonstrated by ONSD. We have considered that arachnoid cysts detected in headaches can create a compression effect and cause the pain to intensify.
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Affiliation(s)
- Esra Sarigecili
- Department of Pediatric Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey.
| | - Sevcan Bilen
- Department of Pediatric Emergency, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Sinem Sari Gokay
- Department of Pediatric Emergency, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Habibe K O C Ucar
- Department of Pediatric Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Maffie J, Sobieski E, Kanekar S. Imaging of Headaches due to Intracranial Pressure Disorders. Neurol Clin 2022; 40:547-562. [PMID: 35871784 DOI: 10.1016/j.ncl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Changes in intracranial pressure are a potentially serious etiology of headache. Headache secondary to changes in intracranial pressure frequently present with characteristic clinical features. Imaging plays a key role in the diagnosis and management of this category of headache. In this article, we will review the physiology, clinical presentation, and key imaging findings of major etiologies of changes in intracranial pressure resulting in headache including obstructive and nonobstructive hydrocephalous, idiopathic intracranial hypertension (IIH), and cerebrospinal fluid (CSF) leak.
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Affiliation(s)
- Jonathon Maffie
- Department of Radiology, Division of Neuroradiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Eric Sobieski
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Sangam Kanekar
- Department of Radiology, Division of Neuroradiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Çankaya I, Bayar Muluk N, Burulday V, Karadeniz Bilgili MY, Özdemir A. Noticable Findings in Cranial MRI of the Patients with Idiopathic Intracranial Hypertension. Am J Rhinol Allergy 2022; 36:415-422. [PMID: 35234081 DOI: 10.1177/19458924211069213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. We investigated the optic nerve, Meckel's cavity, internal carotid artery (ICA) and pituitary findings of IIH by Cranial Magnetic Resonance Imaging (MRI). METHODS Cranial MRI images of 35 adult patients with IIH and 35 adult subjects with normal cranial MRI results (control) were evaluated. Optic nerve diameter (OND), optic nerve sheat diameter (ONSD), OND/ONSD ratio, ON tortuosity, ON protrusion, posterior scleral flattening, ICA transverse diameter, CSF distance in Meckel's cavity and ICA transverse diameter/CSF distance in Meckel's cavity ratio, and pituitary gland measurements (height and transverse dimension; and Optic chiasm- pituitary gland distance) were measured. RESULTS OND and ONSD of the IIH group were significantly higher than those of the control groups at anterior and posterior measurements (p < 0.05). OND/ONSD ratio of the IIH group was lower at anterior measurement; and higher at the posterior measurement than the control group (p < 0.05). Right ICA transverse diameter and bilateral CSF distance in Meckel's cavity of the IIH group were higher than those of the control. Optic chiasm- pituitary gland distance of the IIH group was significantly higher than that of the control group (p < 0.05). CONCLUSION OND/ONSD ratio is different in anterior and posterior measurements. So we recommend measuring OND and ONSD separately in IIH patients to use in the clinical practice. Similarly, optic chiasm-pituitary gland distance is also another point to note for IIH patients on MRI. Our paper adds new approach to IIH in terms of OND/ONSD ratio.
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Affiliation(s)
- Imran Çankaya
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Veysel Burulday
- Faculty of Medicine, Radiology Department, Inönü University, Malatya, Turkey
| | | | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
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Ebrahimzadeh SA, Du E, Chang YM, Bouffard M, Loth F, Bhadelia RA. MRI findings differentiating tonsillar herniation caused by idiopathic intracranial hypertension from Chiari I malformation. Neuroradiology 2022; 64:2307-2314. [PMID: 35697809 DOI: 10.1007/s00234-022-02993-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Some patients with idiopathic intracranial hypertension (IIH) have cerebellar tonsillar herniation ≥ 5 mm mimicking Chiari malformation I (CMI), which can result in misdiagnosis and unjustified treatment. Our purpose was to identify IIH patients with tonsillar herniation ≥ 5 mm (IIHTH) and compare with CMI patients to assess imaging findings that could distinguish the two conditions. METHODS Ninety-eight patients with IIH, 81 patients with CMI, and 99 controls were retrospectively assessed. Two neuroradiologists blindly reviewed MR images. IIHTH patients were compared with CMI patients and controls regarding the extent of tonsillar herniation (ETH), bilateral transverse sinus stenosis (BTSS), hypophysis-sella ratio (HSR), and bilateral tortuosity of optic nerve (BTON). RESULTS 13/98 (13.2%) IIH patients had tonsillar herniation ≥ 5 mm (IIHTH) and were significantly younger and had higher BMI compared with CMI patients and controls. ETH was significantly less in the IIHTH than CMI (6.5 ± 2.4 mm vs. 10.9 ± 4.4 mm; p < 0.001). BTSS and HSR < 0.5 were more common in IIHTH than CMI (p < 0.001 and p = 0.003, respectively). No differences were seen between CMI and controls. BTON was significantly more common in IIHTH compared to control (p = 0.01) but not to the CMI (p = 0.36). Sensitivity and specificity to differentiate IIHTH from CMI were 69.2% and 96.1% for BTSS and 69.2% and 75.3% for HSR < 0.5. CONCLUSION The presence of BTSS and/or HSR < 0.5 in patients with ETH ≥ 5 mm should suggest further evaluation to exclude IIH before considering CMI surgery.
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Affiliation(s)
- Seyed Amir Ebrahimzadeh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCB90, 330 Brookline Ave, Boston, MB, 02215, USA.
| | - Elizabeth Du
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCB90, 330 Brookline Ave, Boston, MB, 02215, USA
| | - Yu-Ming Chang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCB90, 330 Brookline Ave, Boston, MB, 02215, USA
| | - Marc Bouffard
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francis Loth
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCB90, 330 Brookline Ave, Boston, MB, 02215, USA
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Lerner A, Sheikh-Bahaei N, Go JL. Utility of Neuroimaging in the Management of Chronic and Acute Headache. Otolaryngol Clin North Am 2022; 55:559-577. [PMID: 35490044 DOI: 10.1016/j.otc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging plays an important role in identifying the cause of the much less common secondary headaches. Such headaches may be caused by a variety of pathologic conditions which can be categorized as intracranial and extracranial. Idiopathic intracranial hypertension imaging findings include "empty sella," orbital changes, and dural venous sinus narrowing. Intracranial hypotension (ICH) is frequently caused by CSF leaks. Imaging findings include loss of the CSF spaces, downward displacement of the brain, as well as dural thickening and enhancement. Severe cases of ICH may result in subdural hematomas. A variety of intracranial and skull base tumors may cause headaches due to dural involvement. Extracranial tumors and lesions that frequently present with headaches include a variety of sinonasal tumors as well as mucoceles. Neurovascular compression disorders causing headaches include trigeminal and glossopharyngeal neuralgia. Imaging findings include displacement and atrophy of the cranial nerve caused by an adjacent arterial or venous structure.
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Affiliation(s)
- Alexander Lerner
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA.
| | - Nasim Sheikh-Bahaei
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
| | - John L Go
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
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Zhao K, Gu W, Liu C, Kong D, Zheng C, Chen W, Li X, Liang Y, Zhou H. Advances in the Understanding of the Complex Role of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension. J Magn Reson Imaging 2022; 56:645-654. [PMID: 35357056 PMCID: PMC9541264 DOI: 10.1002/jmri.28177] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) that predominantly affects young obese women. IIH is a diagnosis of exclusion. That is, if increased ICP is suspected, magnetic resonance imaging and magnetic resonance venography of the brain are recommended to exclude secondary causes. Imaging findings, such as empty sella, orbital findings, meningocele, and encephalocele, are not diagnostic of ICP, nor does their absence exclude ICP either. Therefore, venous manometry is recommended as the gold standard for evaluation, regardless of previous anatomic imaging results. Venous manometry is an invasive examination that is frequently applied to derive physiologic information concerning the nature of the pressure gradient. However, the pathogenesis of IIH has not been fully elucidated. The presence of venous sinus stenosis in a subset of patients has provided some support for the potential mechanisms underlying this condition. Hence, this review provides an up‐to‐date discussion on the potential pathogenic mechanisms of IIH with a special focus on venous sinus stenosis.
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Affiliation(s)
- Kexin Zhao
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Gu
- Department of Otorlaryngology, The First Hospital of Jilin University, Changchun, China
| | - Chunmei Liu
- Department of Gynecology, Changchun Obstetrics Gynecology Hospital, Changchun, China
| | - Derui Kong
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Chong Zheng
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Wei Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xuewei Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yuchen Liang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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Witsberger EM, Huston J, Cutsforth-Gregory JK, Johnson PW, Bhatti MT, Chen JJ. Population-Based Evaluation of Indirect Signs of Increased Intracranial Pressure. J Neuroophthalmol 2022; 42:e63-e69. [PMID: 34334756 DOI: 10.1097/wno.0000000000001329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Mayo Clinic Study of Aging (MCSA) is a unique prospective study that systematically evaluates the normal aging population and includes many participants undergoing both MRI and lumbar puncture (LP). Using MCSA date, we aimed to determine the prevalence of indirect signs of raised intracranial pressure (ICP) on MRI and whether these correlate with LP opening pressure (OP). This is a large-scale study that evaluates how often indirect signs of increased ICP occur in a normal population. METHODS MCSA participants who had an MRI within 3 months of an LP with recorded OP were included in the study. MRIs were reviewed for indirect signs of raised ICP, including pituitary to sella (P/S) ratio, cerebellar tonsillar ectopia, and optic nerve sheath diameter (ONSD). These signs were evaluated for correlations with OP and influences from body mass index (BMI) and obstructive sleep apnea (OSA). RESULTS Five hundred ninety-seven MCSA patients were identified who underwent both LP and MRI. Two hundred sixty (43.6%) were women. The median age was 70.7 years (range 32.6-92.7). Median OP was 152 mm H2O (range 60-314 mm H2O), with 91 (15.2%) participants having an OP ≥ 200 mm H2O. Empty or partially empty sella was seen in 81 (12.8%) of the cohort. The P/S ratio decreased with increasing OP (r = -0.3, P < 0.001). There was a weak correlation between OP and average ONSD (r = 0.184, P = 0.01), which was no longer significant when accounting for age, gender, and BMI (partial r2 = 0.014, P = 0.097). There was no correlation between OP and cerebellar tonsillar ectopia. OSA was associated with increased ONSD (P = 0.004), but this did not remain statistically significant after accounting for age, gender, and BMI (P = 0.085). CONCLUSION Smaller pituitary gland size correlated with increasing OP. This suggests that ICP is a continuum with some normal individuals demonstrating asymptomatic radiologic signs of raised ICP.
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Affiliation(s)
- Emily M Witsberger
- Departments of Ophthalmology (EMW, JH, MTB, JJC), Radiology (JH, MTB, JJC), and Neurology (JKC-G), Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and Department of Biomedical Statistics and Informatics (PWJ), Mayo Clinic College of Medicine and Science, Jacksonville, Florida
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Wang MTM, Prime ZJ, Xu W, McKelvie J, Papchenko T, Padungkiatsagul T, Moss HE, Danesh-Meyer HV. Diagnostic performance of neuroimaging in suspected idiopathic intracranial hypertension. J Clin Neurosci 2022; 96:56-60. [PMID: 34974249 PMCID: PMC9159900 DOI: 10.1016/j.jocn.2021.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/18/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023]
Abstract
The diagnostic utility of neuroradiologic signs associated with idiopathic intracranial hypertension (IIH) for the evaluation of patients presenting with papilloedema remains yet to be elucidated. This multicentre retrospective cohort study assessed consecutive patients presenting with suspected papilloedema to Auckland District Health Board (NZ) and Stanford University Medical Centre (US), between 2005 and 2019, undergoing magnetic resonance imaging and venography (MRI/MRV) or computed tomography and venography (CT/CTV) prior to lumbar puncture assessment for diagnostic suspicion of IIH. Data were collected regarding demographic, clinical, radiologic, and lumbar puncture parameters, and the diagnosis of IIH was determined according to the Friedman criteria for primary pseudotumor cerebri syndrome. A total of 204 participants (174 females; mean ± SD age 29.9 ± 12.2 years) were included, and 156 (76.5%) participants fulfilled the diagnostic criteria for IIH. The presence of any IIH-associated radiologic sign on MRI/MRV demonstrated a sensitivity (95% CI) of 74.8% (65.8%-82.0%) and specificity (95% CI) of 94.7% (82.7%-98.5%), while radiologic signs on CT/CTV exhibited a sensitivity (95% CI) of 61.0% (49.9%-71.2%) and specificity (95% CI) of 100.0% (83.2%-100.0%). In summary, the modest sensitivities of radiologic signs of IIH would support the routine use of lumbar puncture assessment following neuroimaging to secure the diagnosis. However, the high specificities might lend limited support for the judicious deferment of lumbar puncture assessment among typical IIH demographic patients who consent to the inherent small risk of missed pathology, which has been proposed by some clinicians.
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Affiliation(s)
- Michael T. M. Wang
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Zak J. Prime
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - William Xu
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - James McKelvie
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Taras Papchenko
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States,Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California, United States
| | - Helen V. Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Yadete T, Isby I, Patel K, Lin A. Spontaneous globe subluxation: a case report and review of the literature. Int J Emerg Med 2021; 14:74. [PMID: 34922434 PMCID: PMC8903654 DOI: 10.1186/s12245-021-00398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Case presentation A 48-year-old female presented to the ED with her right eye out of its socket. She reported blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared whole and round. She was also unable to count fingers with the affected eye. There was no visible trauma to the face. Multiple wet gauzes with sterile saline were placed over the displaced eyeball. Direct and even pressure was applied on the globe. Within 30 s, the globe was reduced back in. The patient was able to close her eyelids and reports substantial pain relief with reduction. A CT scan of the orbits was then obtained, demonstrating mild bilateral proptosis. The globes were normal and symmetric. No intraconal or extraconal abscess or infection was seen. There were no intraconal or extraconal masses. There was no acute orbital traumatic injury, no avulsion of the optic nerve, ocular rupture, or retrobulbar hematoma. After reviewing the case with an ophthalmologist, a follow-up appointment with the ophthalmologist was arranged. The patient was discharged on erythromycin ointment. Post-discharge investigation of the CT imaging revealed dilated optic nerve sheaths, tortuosity of the optic nerve, and empty sella. Conclusions In addition to causing distress and severe anxiety, SGS poses numerous immediate as well as long-term complications. Traction of the optic nerve and retinal vasculature may potentially cause retinal venous congestion and loss of visual acuity with potential vision loss. In the absence of known risk factors or disease processes, orbital imaging and serological studies for thyroid ophthalmopathy should be considered.
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Affiliation(s)
- Tesfaye Yadete
- Kirk Kerkorian School of Medicine at UNLV, 2040 W Charleston Blvd 3rd Floor, Las Vegas, NV, 89102, USA.
| | - Ian Isby
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, 901 Rancho Lane, Ste 135, Las Vegas, NV, 89106, USA
| | - Ketan Patel
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, 901 Rancho Lane, Ste 135, Las Vegas, NV, 89106, USA
| | - Alex Lin
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, 901 Rancho Lane, Ste 135, Las Vegas, NV, 89106, USA
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Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension. Acta Neurol Belg 2021; 121:1567-1573. [PMID: 32666506 DOI: 10.1007/s13760-020-01415-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Increased intracranial hypertension (IIH) is a defined clinical condition; however, an unsolved pathophysiologic background usually creates problems in its diagnosis and proper approach. The aim of this study was to emphasize the clinical conditions and brain magnetic resonce imaging (MRI) clues of pediatric patients, especially this clinical entity with high morbidity. Here, we review the etiology, clinical presentation, brain MRI findings, and prognosis of IIH in children. The symptoms' onset age ranged from 9 months to 16 years. Headache (81%), vomiting (37%), and diplopia (33.3%) were the most frequent symptoms. The most common etiologic factors were found to be obesity and dural venous sinus thrombosis. Cerebrospinal fluid (CSF) opening pressure had mean a mean value of 615.2 ± 248 mm H2O. A significant relationship was found between visual field impairment and height of CSF pressure (p < 0.001). Optic nerve sheath enlargement (88.8%) and optic nerve tortuosity (85.1%) were found as the most common brain MRI findings. Slit-like ventricle (37%), venous sinus thrombosis (29.6%), posterior globe sclera flattening (29.6%), empty sella (25.9%), and intraocular protrusion of the optic nerve (14.8%) were the other findings. A significant relationship was found between CSF opening pressure and the presence of optic nerve tortuosity (p = 0.002), and distension of the optic nerve sheath (p = 0.006). All patients received acetazolamide, only one patient underwent lumboperitoneal shunt, and only one received steroids. In children, IIH can present with different etiologies and symptoms. Brain MRI provides crucial clues in diagnosis. Urgent diagnosis and treatment planning are required to protect vision functions.
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Rupa V, Jasper A, Abraham L, Rajshekhar V. MR findings suggestive of idiopathic intracranial hypertension in 117 patients with spontaneous cerebrospinal fluid rhinorrhea. Neuroradiology 2021; 64:949-958. [PMID: 34677642 DOI: 10.1007/s00234-021-02840-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to document the prevalence of MR findings suggestive of idiopathic intracranial hypertension (IIH) in patients undergoing endoscopic repair of spontaneous CSF rhinorrhea (SCSFR). METHODS In a retrospective study, MR images of 117 consecutive patients who had undergone endoscopic repair of SCSFR were evaluated for features suggestive of IIH (empty sella, widened optic nerve sheath, tortuous optic nerve, flattened posterior globe, and enlarged Meckel's cave). Pituitary height was used to diagnose partial and complete empty sella. MR images were independently evaluated by two of the authors without knowledge of the clinical findings. Consensus method was used to resolve differences between the two evaluators. RESULTS Empty or partially empty sella was diagnosed in the MR of 105 (89.7%) patients. In 38/105 (36.2%) patients with empty/partial empty sella, no additional MR findings were present. In 43/105 (41%) patients, one or more of the MR features with high specificity for diagnosis of IIH (flattened posterior globe and enlarged Meckel's cave) were seen. In the other 24 (22.9%) additional MR findings, less specific for IIH (widened optic nerve sheath, tortuous optic nerve) were noted. Papilledema was seen in 11 of 60 (18.3%) patients who underwent funduscopic examination. All patients with papilledema had empty/partial empty sella, and 9/11 (81.8%) had an additional MR finding suggestive of IIH. CONCLUSION The majority of patients with SCSFR have MR imaging features of IIH. These imaging features should be a major component of previously published modified diagnostic criteria for IIH in patients with SCSFR.
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Affiliation(s)
- V Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Anitha Jasper
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Lisa Abraham
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, 632004, India.
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Kamali A, Aein A, Naderi N, Choi SJ, Doyle N, Butler IJ, Huisman TAGM, Bonfante EE, Sheikh-Bahaei N, Khanpara S, Patel RP, Riascos RF, Zhang X, Tang RA, Radmanesh A. Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study. J Child Neurol 2021; 36:1103-1110. [PMID: 34747259 DOI: 10.1177/08830738211045234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A cutoff value of 6.0 mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.
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Affiliation(s)
- Arash Kamali
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Azin Aein
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Niyousha Naderi
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sally J Choi
- 12339University of Texas Medical School, Health Science Center at Houston, Houston, TX, USA
| | - Nathan Doyle
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ian J Butler
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thierry A G M Huisman
- Departments of Pediatrics and Radiology, 3984Texas Children Hospital, 3989Baylor College of Medicine, Houston, TX, USA
| | - Eliana E Bonfante
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nasim Sheikh-Bahaei
- Department of Diagnostic Radiology, Division of Neuroradiology, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Shekhar Khanpara
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajan P Patel
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy F Riascos
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xu Zhang
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rosa A Tang
- Department of Neurosurgery, Neuro-ophthalmology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alireza Radmanesh
- Department of Diagnostic Radiology, Division of Neuroradiology, 12297Langone Medical Center, New York University, New York, NY, USA
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Prabhat N, Chandel S, Takkar DA, Ahuja C, Singh R, Kathirvel S, Lal V. Sensitivity and specificity of neuroimaging signs in patients with idiopathic intracranial hypertension. Neuroradiol J 2021; 34:421-427. [PMID: 33678064 PMCID: PMC8559014 DOI: 10.1177/19714009211000623] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The primary role of neuroimaging in idiopathic intracranial hypertension (IIH) is to exclude secondary causes of raised intracranial pressure. Recently, a few imaging markers have been described which may suggest diagnosis of IIH in atypical cases. We carried out this study to assess the prevalence and accuracy of these neuroimaging signs in predicting the diagnosis of IIH. METHODS Eighty treatment-naive patients with IIH and 30 controls were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging was done in all patients. RESULTS The most common abnormality noted was optic nerve tortuosity in 82.5% of patients, followed by posterior scleral flattening in 80%, perioptic subarachnoid space (SAS) dilatation in 73.8% and partial empty sella in 68.8% of patients. The presence of optic nerve tortuosity was the most sensitive sign on neuroimaging, though the highest specificity was seen for posterior scleral flattening and perioptic SAS dilatation. The presence of more than three neuroimaging features correlated with severity of vision loss. CONCLUSION In suggestive clinical scenarios, posterior scleral flattening, perioptic SAS dilatation and optic nerve tortuosity are highly sensitive and specific signs in IIH. This study also highlights the utility of MRI as a valuable tool for prognosis of visual outcome in patients with IIH.
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Affiliation(s)
- Nandita Prabhat
- Department of Neurology, Postgraduate Institute of Medical
Education and Research (PGIMER), India
| | - Shivani Chandel
- Department of Internal Medicine, Postgraduate Institute of
Medical Education and Research (PGIMER), India
| | - Dr Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical
Education and Research (PGIMER), India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical
Education and Research (PGIMER), India
| | - Ramandeep Singh
- Department of Ophthalmology, Postgraduate Institute of Medical
Education and Research (PGIMER), India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health,
Postgraduate Institute of Medical Education and Research (PGIMER), India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical
Education and Research (PGIMER), India
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Song S, Chang D, Li H, Liu C, Li H, Cui Y. Application of optic neuro-ophthalmology imaging in latent meningeal metastases of lung cancer. Thorac Cancer 2021; 12:2614-2617. [PMID: 34505347 PMCID: PMC8487808 DOI: 10.1111/1759-7714.14128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022] Open
Abstract
Latent intracranial meningeal metastases (IMM) of lung cancer is difficult to determine, yet it is critical to do so given that it impacts the treatment agent. Studies on this disease are rare, thus necessitating further investigation. As a case study, we will explore the application of optic neuroimaging in IMM. A 62-year-old female patient was diagnosed with lung adenocarcinoma, which had progressed to osseous metastasis. During the course of chemotherapy, the patient had bilateral vision loss and paralysis of extraocular muscles. Ophthalmologists ruled out disease of the retina and suspected intracranial metastasis; however, brain-enhanced magnetic resonance angiography and magnetic resonance venography were normal. Given the patient's severe osteoarthropathy and poor physical condition, she refused to undergo a lumbar puncture examination. Optic neuro-ophthalmology imaging was ultimately used. Utilizing optical coherence tomography, we found that the basement membrane layer in the papilledema was protruding up towards the vitreous cavity. To assist in visualization, the optic nerve sheath was enhanced with optic magnetic resonance imaging. With these methods, the dural metastasis was identified, the treatment agent was changed for the patient, and she had a successful recovery. Thus, optic neuro-ophthalmology imaging should be recommended for patients who are in the latent course of dural metastasis, and it could also be used to evaluate therapeutic efficacy.
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Affiliation(s)
- Shuai Song
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dong Chang
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunquan Liu
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Marashdeh WM, Al Qaralleh MA, Hdeeb AH. Quantitative parameters for diagnosis of idiopathic intracranial hypertension on brain MRI. Eur J Radiol Open 2021; 8:100371. [PMID: 34485627 PMCID: PMC8403732 DOI: 10.1016/j.ejro.2021.100371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
Optic nerve diameter on MRI correlates with Lumbar puncture opening pressure. There is a significant difference in optic nerve diameter on MRI between IIH patients and control patients. There is a reverse regression relationship between pituitary height and lumbar puncture opening pressure. Receiver operator curve (ROC) analysis showed high accuracy for optic nerve diameter in differentiating between IIH and control groups. ROC analysis also showed moderate accuracy for Neck fat thickness and low accuracy for Meckel’s cave diameter and for pituitary height measurement. Purpose Aim of this study was to develop quantitative parameters for diagnosing Idiopathic Intracranial Hypertension (IIH) using brain MRI scans. Methods This is a case control study with 48 cases and 192 matched controls. Optic nerve diameter (OND), Pituitary height (PH), Meckel’s cave diameter (MCD), and Neck fat thickness (NFT) were measured for both groups. Consequently, means were obtained for the different parameters in both groups with subsequent establishment of best cutoffs using Receiver Operator Curve (ROC) analysis. Results For IIH patients the means of OND, PH, MCD, and NFT were 6.2 mm, 3.9 mm, 5 mm, 1.4 cm, respectively while for controls the means were 4.6 mm, 4.5 mm, 4.3 mm, and 0.8 cm with statistical significance between the two groups. ROC analysis showed the cutoff points with best accuracy for the above parameters in diagnosing IIH to be 5.4 mm for OND with sensitivity of 0.77 and specificity of 0.85 representing high accuracy, while for PH a cutoff point of 3 mm showed low accuracy with sensitivity of 0.54 and specificity of 0.7, and a MCD cutoff of 4.5 mm also showed low accuracy with sensitivity of 0.6 and specificity of 0.59, meanwhile a cutoff point of 1.1 cm for NFT was moderately accurate with sensitivity of 0.70 and specificity of 0.81. Conclusion Statistical difference in the means for OND, PH, MCD, and NFT between IIH patients and controls is established. Also, we provide cut off points for these parameters to diagnose IIH on brain MRI.
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Affiliation(s)
- Wael M Marashdeh
- Jordan University of Science and Technology, King Abdullah University Hospital, Department of Diagnostic Radiology and Nuclear Medicine, Jordan
| | - Mohammad A Al Qaralleh
- Jordan University of Science and Technology, King Abdullah University Hospital, Department of Diagnostic Radiology and Nuclear Medicine, Jordan
| | - Ahmad H Hdeeb
- Jordan University of Science and Technology, King Abdullah University Hospital, Department of Diagnostic Radiology and Nuclear Medicine, Jordan
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