Neuroimaging Features of Idiopathic Intracranial Hypertension Persist After Resolution of Papilloedema

Abstract

Papilloedema is a key clinical finding in the diagnosis of idiopathic intracranial hypertension (IIH). However, newly proposed criteria allow diagnosis without papilloedema only if certain neuroimaging features are present. It is currently unclear if these findings persist upon resolution of papilloedema and IIH. A retrospective chart review identified three groups of patients (six per group) who had received orbital imaging within 4 weeks of fundoscopic examination: (1) IIH patients without active papilloedema, (2) IIH patients with active papilloedema, and (3) patients with no history of IIH or papilloedema. All magnetic resonance imaging (MRI) scans were graded by a neuroradiologist who was blinded to clinical status. Neuroimaging features were compared by using the Kruskal-Wallis one-way analysis of variance. Measurements of sellar and optic nerve configuration showed a statistical trend with papilloedema status. For the control group versus the active papilloedema group, the values were 0.0597 and 0.0621, respectively. For the control group versus the resolved papilloedema group, the values were 0.0485 and 0.0512, respectively. However, globe and sellar values for the resolved papilloedema group versus the active papilloedema group were 1.000 and 0.6023, respectively, and not significant. Sellar and globe configuration suggest that a statistical trend for persistence after papilloedema has resolved and intracranial pressure (ICP) has normalised. Careful clinical correlation and fundus examination are essential because some of these neuroimaging features can be seen in normal patients and those with resolved IIH, and their presence on MRI may not necessarily indicate active disease or elevated ICP.

Case Report: Pituitary Morphology and Function Are Preserved in Female Patients With Idiopathic Intracranial Hypertension Under Pharmacological Treatment

“…Noteworthy, the patients were being treated with acetazolamide, that has been shown to induce complete recovery of papilledema and improvement in the height of the midsagittal pituitary height, possibly affecting the observed results ( 11 , 24 ). On the other hand, the re-expansion of the pituitary gland does not occur as rapidly as the resolution of papilledema, and in fact some authors propose to integrate the follow-up not only with the fundus oculi evaluation, but also with MRI, as the persistence of an ES and posterior globe flattening may be useful for IIH detection even after the resolution of papilledema and the normalization of ICP ( 25 ). It should also be emphasized that acetazolamide has not always proved effective in restoring the pituitary morphology, which was then achieved through a lumboperitoneal shunt ( 11 ) or serial lumbar punctures ( 26 ).…”

Lamina cribrosa surface position in idiopathic intracranial hypertension with swept-source optical coherence tomography

“…A recent study showed that the optic nerve configuration does not return to baseline values after CSF pressure-lowering therapy. [16] Because all of the patients in our study with IIH had grades 1–3 papilledema at the time of imaging – indicating that the CSF pressure was still high – our LC measurements may reflect the chronic structural changes seen in IIH cases.…”

An Update on Imaging in Idiopathic Intracranial Hypertension

“…It is not entirely clear how a long-term increase of ICP causes the size reduction of the pituitary gland, but it is thought to be the result of a herniation of arachnocele through the diaphragma sellae (25). Interestingly, most abnormal morphometric neuroimaging findings do not improve after CSF pressure has been normalized and papilledema has resolved (26). However, healthy participants in research studies or patients who are scanned for a different reason may show an "empty sella."…”