Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema

Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema: Objective:

Revised diagnostic criteria for idiopathic intracranial hypertension (IIH) were proposed in part to reduce misdiagnosis of intracranial hypertension without papilledema (WOP) by using 3 or 4 MRI features of intracranial hypertension when a sixth nerve palsy is absent. This study was undertaken to evaluate the sensitivity and specificity of the MRI criteria and to validate their utility for diagnosing IIH in patients with chronic headaches and elevated opening pressure (CH + EOP), but WOP.

Methods:

Brain MRIs from 80 patients with IIH with papilledema (WP), 33 patients with CH + EOP, and 70 control patients with infrequent episodic migraine were assessed in a masked fashion for MRI features of intracranial hypertension.

Results:

Reduced pituitary gland height was moderately sensitive for IIH WP (80%) but had low specificity (64%). Increased optic nerve sheath diameter was less sensitive (51%) and only moderately specific (83%). Flattening of the posterior globe was highly specific (97%) but had low sensitivity (57%). Transverse venous sinus stenosis was moderately sensitive for IIH WP (78%) but of undetermined specificity. A combination of any 3 of 4 MRI features was nearly 100% specific, while maintaining a sensitivity of 64%. Of patients with CH + EOP, 30% had 3 or more MRI features, suggesting IIH WOP in those patients.

Conclusion:

A combination of any 3 of 4 MRI features is highly specific for intracranial hypertension and suggests IIH WOP when present in patients with chronic headache and no papilledema.

Address correspondence to Robert M. Mallery, MD, Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road Boston, MA 02115; E-mail: rmallery@partners.org.

L. Ledbetter receives royalties from Elsevier for being a contributing author of Diagnostic Imaging: Head and Neck, Third Edition. M. A. Tamhankar is a Principal Investigator for Quark Pharmaceuticals and is currently conducting a research study on studying the efficacy of an experimental drug in patients with nonarteritic ischemic optic neuropathy. K. S. Shindler is supported by NIH grant #EY015014, by a Research to Prevent Blindness Physician Scientist Award, by the F. M. Kirby Foundation, receives royalties for an article published in UpToDate, has served as a scientific advisory board member and received consulting fees from Noveome Biotherapeutics, Inc (formerly Stemnion, Inc.), and Noveome has provided unrestricted funds to the University of Pennsylvania to support research in K. S. Shindler's laboratory. K. B. Digre receives royalties from Springer for being an author of Lee and Digre; A Case-Based Guide to Eye Pain. She is supported in part by an Unrestricted Grant from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. She is the president of the American Headache Society. D. I. Friedman has served on advisory boards for Alder BioPharmaceuticals, Amgen, Avanir, electroCore, Supernus, Teva Pharmaceuticals, and Zosano. She is on the speaker's bureau for Allergan, electroCore, Supernus, and Teva Pharmaceuticals, and has received grant support from Merck, Eli Lilly, and Autonomic Technologies, Inc. She is on the editorial boards of Neurology Reviews and Headache, and is a contributing author for MedLink Neurology and Medscape. She is a member of the Board of Directors of the American Headache Society. G. T. Liu receives royalties from Elsevier for being a coauthor of Liu, Volpe, and Galetta's Neuro-ophthalmology: Diagnosis and Management. The remaining authors have no conflicts of interests to disclose.

© 2019 by North American Neuro-Ophthalmology Society