Imaging Features of Idiopathic Intracranial Hypertension in Children

Abstract

Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel's cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (<11 years, n = 10) had lower frequencies of scleral flattening (50% vs 89% and 85%, P = .02), increased perioptic cerebrospinal fluid (60% vs 84% and 89%, P = .08), optic nerve tortuosity (20% vs 46% and 59%, P = .07), empty or partially empty sella (56% vs 78% and 93%, P = .007), and TSS (67% vs 93% and 96%, P = .04). Children with idiopathic intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.

B-Mode Transorbital Ultrasonography for the Diagnosis of Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

“…The widening of the perineural space surrounding the optic nerve and the corresponding increased ONSD values are secondary to the increased ICP and correlate with signs of cerebral hypertension detected using other neuroimaging techniques [21,22]. This finding is easily explained by the connection of the perineural space surrounding the optic nerve with the meninges of the central nervous system.…”

Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

“…A number of radiographic findings have been associated with pseudotumor cerebri syndrome. 31,32 In our study, we found a relatively low percentage of patients with MRI abnormalities (approximately 20% of patients) (see Table 4). In the pseudotumor cerebri syndrome imaging literature, which is predominantly focused on adult pseudotumor cerebri syndrome, MRI abnormalities have been identified in up to 90% of patients.…”

Idiopathic Intracranial Hypertension in Children and Adolescents: An Update

“…Interestingly, findings such as scleral flattering, transverse sinus stenosis and sella turca (Fig. ) changes were reported at lower frequencies in prepuberal children compared to adolescents and adults in a case series by Hartmann et al, probably due to shorter duration of symptoms in this group. Except for meningoceles, all radiological signs of increased intracranial pressure previously described for adults have been identified in children.…”