Magnetic Resonance Imaging Features and Clinical Findings in Pediatric Idiopathic Intracranial Hypertension: A Case–Control Study

Abstract

The purpose of this study is to identify salient magnetic resonance imaging (MRI) findings of pediatric IIH, to determine the relevance of these findings with regard to disease pathogenesis, and to relate these findings to the clinical presentation towards identification of risk factors of disease. A retrospective, a case–control study of 38 pediatric patients with and 24 pediatric patients without IIH from the ophthalmology department at a tertiary care center was performed. Clinical data, including ophthalmic findings and lumbar puncture results, were recorded. Neuroimaging, including both MRI and magnetic resonance venography (MRV), was evaluated for perioptic subarachnoid space diameter enlargement, posterior globe flattening, optic nerve head protrusion, empty or partially empty sella turcica, dural venous sinus abnormalities, skull base crowding, and prominent arachnoid granulations. Compared with controls, IIH patients had larger perioptic subarachnoid space diameters, higher incidences of posterior globe flattening, protrusion of the optic nerve heads, an empty sella turcica, and dural venous sinus abnormalities. A perioptic subarachnoid space diameter of ≥5.2 mm was identified as an independent predictor of IIH (p < 0.001) with sensitivity of 87% and specificity of 67%. Several significant MRI findings in pediatric IIH were identified. Using a model that uniquely incorporated clinical and MRI findings at presentation, we provide a framework for risk stratification for the diagnosis of pediatric IIH which may be utilized to facilitate diagnosis. Future prospective work is needed to further validate the model developed in this study.

Pediatric intracranial hypertension: A review of presenting symptoms, quality of life, and secondary causes

“…Gilbert et al documented that PIH patients had larger dilated optic nerve sheaths and higher rates of optic nerve head protrusion, posterior globe flattening, empty sella, and venous sinus abnormalities compared with controls. 50 The optic nerve sheath diameter of 5.2 mm or greater was an independent predictor of PIH, with 87% sensitivity and 67% specificity. Hartmann et al found prepubertal patients had lower rates of posterior globe flattening, dilated optic nerve sheaths, tortuous optic nerves, empty/partially empty sella, and TSS compared with adolescents and adults.…”

“…Gilbert et al documented that PIH patients had larger dilated optic nerve sheaths and higher rates of optic nerve head protrusion, posterior globe flattening, empty sella, and venous sinus abnormalities compared with controls 50 . The optic nerve sheath diameter of 5.2 mm or greater was an independent predictor of PIH, with 87% sensitivity and 67% specificity.…”

Evolving Evidence in Idiopathic Intracranial Hypertension

“…Diagnosing and managing IIH can be challenging [2] and selected articles underlined the importance of the multidisciplinary team in joint pathways where specialists worked together to provide the best care for patients [1,6,8]. A number of articles investigated methods to aide diagnostic certainty and enable stratification of the disease [9][10][11][12]. An exploratory study used a handheld device to measure the photopic flash electroretinogram and record the photopic negative response.…”

“…Gilbert et al analysed a case-control study utilizing MRI findings to build a framework for risk stratification for the diagnosis of pediatric IIH. Whilst prospective validation of their model is required, this analysis defined a cut-off point for the perioptic nerve sheath diameter (>5.2 mm) which, when measured according to the technique outlined, had a high sensitivity and specificity for detection of papilledema in pediatric IIH [10]. Mehr et al also chose to investigate the MRI features that are characteristic in IIH.…”