Abstract
Purpose :
MRI signs suggesting intracranial hypertension are common in patients with idiopathic intracranial hypertension (IIH), but are also incidentally detected in asymptomatic patients and those with primary headache syndromes, prompting neuro-ophthalmology consultations and investigations. We aimed to prospectively identify the prevalence and significance of MRI signs of intracranial hypertension (MRI-IH) in patients imaged for any clinical indication.
Methods :
Prospective study evaluating 296 consecutive patients undergoing outpatient brain MRI and non-mydriatic fundus photography immediately following MRI. Photographs were reviewed for papilledema and MRIs read for MRI-IH. Univariate analysis with Fisher’s exact test or t-test was performed.
Results :
Indications for MRI were brain neoplasm (27.7%), multiple sclerosis (MS)/MS-mimics (18.6%), seizure (17.9%), headache (8.8%), and other non-headache neurologic symptoms (19.6%). Four patients (1.4%) had known IIH. MRI-IH (N, %) included: empty sella (98, 33.1%); enlarged Meckel cave (47, 15.9%); meningocele/cephalocele (4, 1.4%); transverse venous sinus stenosis (TSS) (7/198, 3.6%); cerebellar tonsillar ectopia (4, 1.4%); scleral flattening (2, 0.7%); increased perioptic CSF (32, 10.8%); and increased optic nerve tortuosity (23, 7.8%). Overall, 51% patients exhibited no MRI-IH, 32.8% one sign, 10.8% two signs, 3.7% three signs, and 1.7% had ≥four signs. Five patients (1.7%) had definite papilledema on fundus photographs; two (0.7%) had questionable papilledema. Patients with definite papilledema had significantly increased average BMI (37.6 vs 27.5 kg/m2; P=0.038), history of IIH (40% vs 1%; P=0.001), increased optic nerve tortuosity (60% vs 7%;P=0.004), TSS (50% vs 3%; P=0.006), and ≥four MRI-IH (40% vs 1%; P=0.002), compared to patients without papilledema. Other MRI-IH were not significant, nor were having one, two, or three signs.
Conclusions :
MRI-IH were encountered in almost half the patients in this prospective study of outpatients undergoing brain MRI for various clinical indications. However, definite papilledema was only detected in 1.7% patients, questioning the need to perform systematic investigations for patients with incidentally detected MRI-IH.
This is a 2021 ARVO Annual Meeting abstract.