Magnetic Resonance Imaging Findings of Elevated Intracranial Pressure in Cerebral Venous Thrombosis Versus Idiopathic Intracranial Hypertension with Transverse Sinus Stenosis

Abstract

Purpose To determine whether MRI signs suggesting elevated intracranial pressure (ICP) are preferentially found in patients with idiopathic intracranial hypertension (IIH) than in those with cerebral venous thrombosis (CVT). Methods Among 240 patients who underwent standardized contrast-enhanced brain MRI/MRV at our institution between 9/2009 and 9/2011, 60 with abnormal imaging findings on MRV were included: 27 patients with definite IIH, 2 patients with presumed IIH, and 31 with definite CVT. Medical records were reviewed, and imaging studies were prospectively evaluated by the same neuroradiologist to assess for presence or absence of transverse sinus stenosis (TSS), site of CVT if present, posterior globe flattening, optic nerve sheath dilation/tortuosity, and the size/appearance of the sella turcica. Results 29 IIH patients (28 women, 19 black, median-age 28, median-body mass index, 34) had bilateral TSS. 31 CVT patients (19 women, 13 black, median-age 46, median-BMI 29) had thrombosis of the sagittal (3), sigmoid (3), cavernous (1), unilateral transverse (7), or multiple (16) sinuses or cortical veins (1). Empty/partially-empty sellae were more common in IIH (3/29 and 24/29) than in CVT patients (1/31 and 19/31) (p<0.001). Flattening of the globes and dilation/tortuosity of the optic nerve sheaths were more common in IIH (20/29 and 18/29) than in CVT patients (13/31 and 5/31) (p<0.04). Conclusion Although abnormal imaging findings suggestive of raised ICP are more common in IIH, they are not specific for IIH and are found in patients with raised ICP from other causes such as CVT.

Frequent occurrence of therapeutically reversible cmv-associated encephalopathy during radiotherapy of the brain.

“…Blood and MRIs were also obtained 3 and 6 months after RT or routinely at any time that symptomatic neurological decline was observed. MRIs were screened for any indication of disease progression or increased intracranial pressure, such as empty sella turcica, transverse sinus stenosis, optic disc protrusion, flattening of the posterior globe or prominence of the perioptic nerve CSF spaces, 14 hydrocephalus, or signs of herniation. Peripheral blood was drawn within days of the MRI (days elapsed: 4.88+4.45) and was tested for anti-CMV IgM, anti-CMV IgG, and CMV DNA by the Institute of Clinical and Molecular Virology, Universitä tsklinikum Erlangen (certified according to DIN EN ISO 15189).…”

Empty Sella and Sagittal Sinus Thrombosis in a Woman with Subaortic Stenosise

“…She utilized oral anticoagulant during four years and stopped in the last two months; used paroxetine, valproic acid and quetiapine for one year; and was in regular use of AAS (100 mg daily) and sertraline (50 mg daily) for three months. [4,5,10]. Both types of IH should be investigated by neuroimaging studies including MR and MR/CT venography, because sinus venous occlusions can be the etiology of isolated intracranial hypertension in more than 30% of cases [4,10].…”

“…The sella turcica may be partially or totally filled with cerebrospinal fluid and the hypophysis is compressed; in cases of shrinking or flattening of the gland, Magnetic Resonance (MR) study can show the sella appearing totally or partially empty -the empty sella syndrome [3,4,[6][7][8][9][10][11][12][13]. This condition may be related to SIH or Idiopathic IH (IIH), but the gland volume has no correlation with Intracranial Pressure (ICP) [3,4,9].…”

“…Hypertension (IH) and main symptoms are headaches, seizures, and hemiparesis; major neuroimaging signs are brain edema, cerebral hematoma and subarachnoid hemorrhage [1][2][3][4][5]. Secondary IH (SIH) may be due to tumor, infection, obstruction of CSF flow, and arteriovenous fistula [1][2][3][6][7][8][9][10].…”

“…This condition may be related to SIH or Idiopathic IH (IIH), but the gland volume has no correlation with Intracranial Pressure (ICP) [3,4,9]. IIH (or pseudotumor cerebri), affects up to 35% of population, mainly middle aged obese and hypertensive women (5:1 compared to men) [3][4][5][6][7][8][9][10]12].…”