Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 28;24(1):97.
doi: 10.1186/s10194-023-01641-x.

MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

Gabriel Bsteh #  1   2 , Wolfgang Marik #  3   4 , Nik Krajnc  5   3 , Stefan Macher  5   3 , Christoph Mitsch  6 , Philip Pruckner  5   3 , Klaus Novak  3   7 , Christian Wöber  5   3 , Berthold Pemp  6
Affiliations

MRI features of idiopathic intracranial hypertension are not prognostic of visual and headache outcome

Gabriel Bsteh et al. J Headache Pain. .

Abstract

Background: In idiopathic intracranial hypertension (IIH), certain MRI features are promising diagnostic markers, but whether these have prognostic value is currently unknown.

Methods: We included patients from the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database with IIH according to Friedman criteria and cranial MRI performed at diagnosis. Presence of empty sella (ES), perioptic subarachnoid space distension (POSD) with or without optic nerve tortuosity (ONT), posterior globe flattening (PGF) and transverse sinus stenosis (TSS) was assessed and multivariable regression models regarding visual outcome (persistent visual impairment/visual worsening) and headache outcome (headache improvement/freedom of headache) were fitted.

Results: We included 84 IIH patients (88.1% female, mean age 33.5 years, median body mass index 33.7). At baseline, visual impairment was present in 70.2% and headache in 84.5% (54.8% chronic). Persistent visual impairment occurred in 58.3%, visual worsening in 13.1%, headache improvement was achieved in 83.8%, freedom of headache in 26.2%. At least one MRI feature was found in 78.6% and 60.0% had ≥3 features with POSD most frequent (64.3%) followed by TSS (60.0%), ONT (46.4%), ES (44.0%) and PGF (23.8%). In multivariable models, there was no association of any single MRI feature or their number with visual impairment, visual worsening, headache improvement or freedom. Visual impairment at baseline predicted persistent visual impairment (odds ratio 6.3, p<0.001), but not visual worsening. Chronic headache at baseline was significantly associated with lower likelihood of headache freedom (odds ratio 0.48, p=0.013), but not with headache improvement.

Conclusions: MRI features of IIH are neither prognostic of visual nor headache outcome.

Keywords: Empty sella; Idiopathic intracranial hypertension; Magnetic resonance imaging; Optic nerve tortuosity; Perioptic subarachnoid space distension; Posterior globe flattening; Transverse sinus stenosis; Visual outcome.

PubMed Disclaimer

Conflict of interest statement

GB: has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene/BMS, Lilly, Merck, Novartis, Roche, Sanofi-Genzyme and Teva, and received honoraria for consulting Biogen, Celgene/BMS, Novartis, Roche, Sanofi-Genzyme and Teva. He has received unrestricted research grants from Celgene/BMS and Novartis. WM: declares no conflict of interest relevant to this study. SM: declares no conflict of interest relevant to this study. VS: declares no conflict of interest relevant to this study/ NK: has participated in meetings sponsored by, received speaker honoraria or travel funding from BMS/Celgene, Janssen-Cilag, Merck, Novartis, Roche and Sanofi-Genzyme and held a grant for a Multiple Sclerosis Clinical Training Fellowship Programme from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). PP: declares no conflict of interest relevant to this study. CM: declares no conflict of interest relevant to this study. KN: declares no conflict of interest relevant to this study. CW: has received honoraria consultancy/speaking from Apomedica, Curelator, Eli Lilly, Grünenthal, Hermes, Novartis, Pfizer, Ratiopharm/Teva, and Stada. BP: declares no conflict of interest relevant to this study.

Figures

Fig. 1
Fig. 1
Flow chart of inclusion/exclusion process. MRI: magnetic resonance imaging. VIIH: Vienna Idiopathic Intracranial Hypertension database
See this image and copyright information in PMC

References

    1. Radhakrishnan K, Ahlskog JE, Cross SA et al (1993) Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Descriptive Epidemiology in Rochester, Minn, 1976 to 1990. Arch Neurol-chicago 50(1):78–80 - PubMed
    1. Kilgore KP, Lee MS, Leavitt JA, et al. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology. 2017;124:697–700. doi: 10.1016/j.ophtha.2017.01.006. - DOI - PMC - PubMed
    1. Raoof N, Hoffmann J (2021) Diagnosis and treatment of idiopathic intracranial hypertension. Cephalalgia 18(10):1266–8. 10.1111/j.1468-1331.2011.03372.x. Epub 2011 Mar 22 - PMC - PubMed
    1. Peng MG, Gokoffski KK. Updates on recent developments in idiopathic intracranial hypertension. SN Compr Clin Medicine. 2021;3:1031–1041. doi: 10.1007/s42399-021-00814-6. - DOI
    1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–1165. doi: 10.1212/WNL.0b013e3182a55f17. - DOI - PubMed

LinkOut - more resources