Volumetric Assessment of Optic Nerve Sheath and Hypophysis in Idiopathic Intracranial Hypertension

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

doi:10.3174/ajnr.a3694

Cited by 39 publications

(38 citation statements)

References 37 publications

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“…Our study shows compelling data regarding the role of asymmetry in the bony optic canals in the genesis of very asymmetric papilledema. It is well-known that the orbital part of the peri-optic subarachnoid spaces shows distension in IIH (22,23). However, a previous study of 15 patients with intracranial hypertension in whom 10 had IIH (13) failed to demonstrate asymmetric distension of the peri-optic subarachnoid spaces in patients with unilateral papilledema, but no details regarding the grading of papilledema were provided.…”

Section: Discussionmentioning

confidence: 99%

Asymmetric Papilledema in Idiopathic Intracranial Hypertension

Bidot

Bruce²,

Saindane

et al. 2015

Journal of Neuro-Ophthalmology

105

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Background Very asymmetric papilledema in idiopathic intracranial hypertension (IIH) is rare, and few studies have dealt with this atypical presentation of IIH. Our aim was to describe the clinical and radiologic features of patients with IIH and very asymmetric papilledema. Methods We identified all adult patients from our IIH database with very asymmetric papilledema defined as a ≥2 modified Frisén grade difference between the two eyes. Demographic data and initial symptoms were collected, and all brain imaging studies performed at our institution were reviewed. Results Of the 559 adult patients with definite IIH, 20 (3.6%; 95%CI: 2.3-5.6%) had very asymmetric papilledema at initial evaluation. They were older (39 versus 30 years; p<0.001), had lower cerebrospinal opening pressure (35.5 versus 36 cm of water; p=0.03), and were more likely to be asymptomatic compared to patients with symmetric papilledema (27% versus 3%; p<0.001). Visual fields were worse on the side of the highest-grade papilledema (p=0.02). The bony optic canal was smaller on the side of the lowest-grade edema in all 8 patients (100%) in whom the imaging was sufficient for reliable measurements (p=0.008). Conclusion IIH with very asymmetric papilledema is uncommon. Very asymmetric papilledema may result from differences in size of the bony optic canals, supporting the concept of compartmentation of the peri-optic subarachnoid space.

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Section: Discussionmentioning

confidence: 99%

Asymmetric Papilledema in Idiopathic Intracranial Hypertension

Bidot

Bruce²,

Saindane

et al. 2015

Journal of Neuro-Ophthalmology

105

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“…4), such as flattening of the posterior sclera, prominent subarachnoid spaces along the optic nerves, vertical tortuosity of the optic nerve sheath complex, protrusion or enhancement of the prelaminar optic nerve (57) (58).…”

Section: Imaging Studiesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review

Chiloiro¹,

Giampietro²,

Bianchi³

et al. 2017

European Journal of Endocrinology

113

149

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Primary empty sella (PES) is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degrees of flattening of the pituitary gland in patients without previous pituitary pathologies. PES pathogenetic mechanisms are not well known but seem to be due to a sellar diaphragm incompetence, associated to the occurrence of upper sellar or pituitary factors, as intracranial hypertension and change of pituitary volume. As PES represents in a majority of cases, a neuroradiological findings without any clinical implication, the occurrence of endocrine, neurological and opthalmological symptoms, due to the above describes anatomical alteration, which delineates from the so called PES syndrome. Headache, irregular menses, overweight/obesity and visual disturbances compose the typical picture of PES syndrome and can be the manifestation of an intracranial hypertension, often associated with PES. Although hyperprolactinemia and growth hormone deficit represent the most common endocrine abnormalities, PES syndrome is characterized by heterogeneity both in clinical manifestation and hormonal alterations and can sometime reach severe extremes, as occurrence of papilledema, cerebrospinal fluid rhinorrhea and worsening of visual acuity. Consequently, a multidisciplinary approach, with the integration of endocrine, neurologic and ophthalmologic expertise, is strongly advocated and recommended for a properly diagnosis, management, treatment and follow-up of PES syndrome and all of the related abnormalities.

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“…IIH diagnosis is supported by characteristic MRI findings, including an empty sella, distended optic nerve sheath (ONS), and a posterior flattening of the optic globe. 1,[4][5][6][7][8][9] However, due to the sensitivity and specificity of currently known neuroimaging signs, neuroimaging techniques are not able to replace invasive assessment of CSF pressure.…”

Section: Introductionmentioning

confidence: 99%