Morphometric and volumetric MRI changes in idiopathic intracranial hypertension

Hoffmann, J.; Huppertz, Hans‐Jürgen; Schmidt, Christoph; Kunte, Hagen; Harms, Lutz; Klingebiel, Randolf; Wiener, Edzard

doi:10.1177/0333102413484095

Cited by 96 publications

(114 citation statements)

References 35 publications

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Section: Discussionmentioning

confidence: 99%

“…25,26 In a recent study of patients with IIH, it was found that increased optic nerve sheath diameter identified on MRI scan was 72-80% sensitive and 96% specific for intracranial hypertension. 26 The only other reliable sign was shortening of the pituitary gland that was 88% sensitive and 76% specific. To our knowledge, no study to date has sufficiently correlated these MRI findings with the presence or absence of papilledema or evaluated the frequency and accuracy of reporting these radiographic signs in everyday practice.…”

Section: Discussionmentioning

confidence: 99%

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The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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Purpose To determine the sensitivity and specificity of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in adult patients. Methods The records of all adult patients referred to the neuro-ophthalmology service who underwent orbital ultrasonography for the evaluation of suspected papilledema were reviewed. The details of history, ophthalmologic examination, and results of ancillary testing including orbital ultrasonography, MRI, and lumbar puncture were recorded. Results of orbital ultrasonography were correlated with the final diagnosis of papilledema or pseudopapilledema on the basis of the clinical impression of the neuro-ophthalmologist. Ultrasound was considered positive when the optic nerve sheath diameter was Z3.3 mm along with a positive 301 test. Results The sensitivity of orbital ultrasonography for detection of papilledema was 90% (CI: 80.2-99.3%) and the specificity in detecting pseudopapilledema was 79% (CI: 67.7-90.7%). Conclusions Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive, but less specific in differentiating papilledema from pseudopapilledema in adult patients, and can be useful in guiding further management of patients in whom the diagnosis is initially uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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“…[10,11,12,13] Various pathologic conditions can also be taken into account, when the idiopathic intracranial hypertension occurs more frequently: thus the global incidence of the idiopathic ICH is considered to be 1 -2 cases / 100,000 but, in the case of young and obese women, it has been noticed that the incidence of idiopathic intracranial hypertension reaches 19-25 cases / 100,000.…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

Pseudotumour cerebri Idiopathic intracranial hypertension and vascular intracranial hypertension

Iencean¹,

Iencean²,

Taşcu³

2015

Romanian Neurosurgery

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Abstract:From the first to use of "pseudotumor cerebri" by Nonne in 1904, the historic evolution of the knowledge on pseudotumor cerebri has been marked by several periods (the otologic stage, the neurosurgical stage, the neuro-ophthalmologic stage); today there are clear diagnosis criteria for the idiopathic intracranial hypertension, there is a clear differentiation between idiopathic intracranial hypertension and vascular intracranial hypertension, also the comprehension of the illness pathogeny is based on the dynamics of the intracranial fluids, which allows the auto-regulation of the cerebral circulation within quasi-normal limits, despite the very high intracranial pressure.

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“…Imaging is used predominantly to assure that there is no mass lesion, venous thrombosis, or other cause for the intracranial pressure elevation. The study by Hoffmann et al (1) in this journal is the first prospective, controlled study looking at signs on imaging that will reliably diagnose intracranial hypertension, and these authors supplied actual volumetric and morphometric measurements. They compared imaging characteristics of 25 patients with IIH using modern magnetic resonance imaging to sex, age, and weight matched controls and calculate the specificity and sensitivity of each of the signs.…”

mentioning

confidence: 99%

“…By IHS criteria (which the authors used in making the diagnosis of IIH, see Table 2) (7), criterion D was not met. Comparing the pain analog scale would have been an interesting finding; although many individuals with IIH report headache reduction after a lumbar puncture, it is not universal and has not been reported in a prospective study (1).…”

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confidence: 99%

Imaging characteristics of IIH: Are they reliable?

Digre

2013

Cephalalgia

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Idiopathic intracranial hypertension (IIH) is a disorder causing headache and visual loss due to papilledema and is seen predominantly in women of child bearing age. The diagnosis is usually based on the presence of clinical symptoms (headache, visual symptoms, tinnitus) and clinical signs (papilledema, sixth nerve palsy, visual field defect) of high intracranial pressure. Cerebrospinal fluid (CSF) pressure measures over 250 mm CSF in non-obese individuals measured in the lateral decubitus position. Imaging is used predominantly to assure that there is no mass lesion, venous thrombosis, or other cause for the intracranial pressure elevation. The study by Hoffmann et al. (1) in this journal is the first prospective, controlled study looking at signs on imaging that will reliably diagnose intracranial hypertension, and these authors supplied actual volumetric and morphometric measurements. They compared imaging characteristics of 25 patients with IIH using modern magnetic resonance imaging to sex, age, and weight matched controls and calculate the specificity and sensitivity of each of the signs. They also tried to correlate the clinical findings with the imaging findings.Hoffman et al. (1) found that the most reliable findings of IIH were the diameter of the optic nerve sheath and the presence of an empty sella. The flattening of the globe by a distended nerve sheath was the most specific finding: 100% specific, but it was not sensitive (28%). Although the optic nerve diameters in the orbit were no different from the controls, the optic nerve sheath diameter was significantly enlarged compared with the controls. Using the cut off of 5.60 mm, this sign had a specificity of 96% and a sensitivity of 72-80%. The empty sella sign was evaluated by measuring the height of the pituitary in patients (the cut off was 4.80 mm); this sign was 76% specific and 88% sensitive. They also found that Meckel's cave was longer in IIH than controls, but the width was not helpful. The size of the ventricles and the CSF volume were not helpful signs, corroborating previous findings by other authors (2). Although they found some individuals with IIH had venous sinus narrowing, this finding did not reliably differentiate from normal controls. Venous sinus narrowing was not a universal finding and variations of the venous sinuses were found in normal controls. The authors also found that the severity of the headache, height of CSF pressure and body mass index (BMI) did NOT correlate with any imaging finding or with each other.The importance of this study is that it shows us that imaging characteristics can be useful in making the diagnosis of IIH. Taken with other studies that have looked at imaging characteristics, we begin to understand imaging features that may assist us in making a diagnosis of IIH (Table 1) Clinically the results of this study play a role in several situations. First, in IIH without papilledema, these imaging findings may assist us in making the diagnosis-symptoms of increased intracranial pressure like headache, but...

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Morphometric and volumetric MRI changes in idiopathic intracranial hypertension

Abstract: Our study results indicate that lateral ventricle size is not affected in IIH. In contrast, abnormalities of the pituitary gland and optic nerve sheath were reliable diagnostic signs for IIH.

Cited by 96 publications

References 35 publications

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Pseudotumour cerebri Idiopathic intracranial hypertension and vascular intracranial hypertension

Imaging characteristics of IIH: Are they reliable?

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