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. 2021 Oct;34(5):421-427.
doi: 10.1177/19714009211000623. Epub 2021 Mar 8.

Sensitivity and specificity of neuroimaging signs in patients with idiopathic intracranial hypertension

Nandita Prabhat  1 , Shivani Chandel  2 , Dr Aastha Takkar  1 , Chirag Ahuja  3 , Ramandeep Singh  4 , Soundappan Kathirvel  5 , Vivek Lal  1
Affiliations

Sensitivity and specificity of neuroimaging signs in patients with idiopathic intracranial hypertension

Nandita Prabhat et al. Neuroradiol J. 2021 Oct.

Abstract

Background: The primary role of neuroimaging in idiopathic intracranial hypertension (IIH) is to exclude secondary causes of raised intracranial pressure. Recently, a few imaging markers have been described which may suggest diagnosis of IIH in atypical cases. We carried out this study to assess the prevalence and accuracy of these neuroimaging signs in predicting the diagnosis of IIH.

Methods: Eighty treatment-naive patients with IIH and 30 controls were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging was done in all patients.

Results: The most common abnormality noted was optic nerve tortuosity in 82.5% of patients, followed by posterior scleral flattening in 80%, perioptic subarachnoid space (SAS) dilatation in 73.8% and partial empty sella in 68.8% of patients. The presence of optic nerve tortuosity was the most sensitive sign on neuroimaging, though the highest specificity was seen for posterior scleral flattening and perioptic SAS dilatation. The presence of more than three neuroimaging features correlated with severity of vision loss.

Conclusion: In suggestive clinical scenarios, posterior scleral flattening, perioptic SAS dilatation and optic nerve tortuosity are highly sensitive and specific signs in IIH. This study also highlights the utility of MRI as a valuable tool for prognosis of visual outcome in patients with IIH.

Keywords: Idiopathic intracranial hypertension; empty sella; posterior scleral flattening; tortuous optic nerves.

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Figures

Figure 1.
Figure 1.
Neuroimaging features in IIH. (a) Tortuous optic nerves; (b) posterior sclera flattening; (c) perioptic subarachnoid space dilatation.
Figure 2.
Figure 2.
(a) Normal sella turcica; (b) partial empty sella; (c) transverse sinus stenosis.
See this image and copyright information in PMC

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