Abstract
The purpose of this study is to identify salient magnetic resonance imaging (MRI) findings of pediatric IIH, to determine the relevance of these findings with regard to disease pathogenesis, and to relate these findings to the clinical presentation towards identification of risk factors of disease. A retrospective, a case–control study of 38 pediatric patients with and 24 pediatric patients without IIH from the ophthalmology department at a tertiary care center was performed. Clinical data, including ophthalmic findings and lumbar puncture results, were recorded. Neuroimaging, including both MRI and magnetic resonance venography (MRV), was evaluated for perioptic subarachnoid space diameter enlargement, posterior globe flattening, optic nerve head protrusion, empty or partially empty sella turcica, dural venous sinus abnormalities, skull base crowding, and prominent arachnoid granulations. Compared with controls, IIH patients had larger perioptic subarachnoid space diameters, higher incidences of posterior globe flattening, protrusion of the optic nerve heads, an empty sella turcica, and dural venous sinus abnormalities. A perioptic subarachnoid space diameter of ≥5.2 mm was identified as an independent predictor of IIH (p < 0.001) with sensitivity of 87% and specificity of 67%. Several significant MRI findings in pediatric IIH were identified. Using a model that uniquely incorporated clinical and MRI findings at presentation, we provide a framework for risk stratification for the diagnosis of pediatric IIH which may be utilized to facilitate diagnosis. Future prospective work is needed to further validate the model developed in this study.
Highlights
Pediatric patients with idiopathic intracranial hypertension (IIH) have the potential for profound, irreversible vision loss from papilledema [1,2]
In adults with idiopathic intracranial hypertension, patients have been shown to harbor characteristic findings on magnetic resonance imaging (MRI) which are suggestive of elevated intracranial pressure, and which facilitate in diagnosis [3]
There have been non-invasive methods which have been utilized such as ocular ultrasonography to evaluate for the presence of elevated intracranial pressure, the relationship between the clinical presentation of IIH and neuroimaging findings has not been explored in great detail to determine their relevance as a diagnostic tool for pediatric
Summary
Pediatric patients with idiopathic intracranial hypertension (IIH) have the potential for profound, irreversible vision loss from papilledema [1,2]. Previous work has suggested that features that may occur in pediatric IIH include enlargement of the optic nerve sheath diameters, protrusion of the optic nerve heads, and flattening of the posterior aspects of the globes [4,5,6,7,8,9]. Those studies have not investigated the relevance of these findings in the context of the clinical presentation of pediatric
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