Elsevier

Ophthalmology

Volume 105, Issue 9, 1 September 1998, Pages 1686-1693
Ophthalmology

Magnetic resonance imaging in pseudotumor cerebri

https://doi.org/10.1016/S0161-6420(98)99039-XGet rights and content

Abstract

Objective

To determine whether magnetic resonance (MR) imaging can be used to predict the presence of elevated intracranial pressure.

Design

Retrospective case series.

Participants

Twenty patients with pseudotumor cerebri and 20 control subjects.

Intervention

Magnetic resonance imaging.

Main outcome measures

The presence or absence of the following six neuroimaging signs was measured: (1) flattening of the posterior sclera; (2) enhancement of the prelaminar optic nerve; (3) distension of the perioptic subarachnoid space; (4) intraocular protrusion of the prelaminar optic nerve; (5) vertical tortuosity of the orbital optic nerve; and (6) empty sella.

Results

The MR imaging disclosed flattening of the posterior sclera in 80% of patients with pseudotumor cerebri, empty sella in 70%, distension of the perioptic subarachnoid space in 45%, enhancement of the prelaminar optic nerve in 50%, vertical tortuosity of the orbital optic nerve in 40%, and intraocular protrusion of the prelaminar optic nerve in 30%. Each neuroimaging sign was detected in 5% of control subjects, except for enhancement of the prelaminar optic nerve, which was not detected in control subjects. Based on these MR imaging signs, the examiner was able to predict the presence of elevated intracranial pressure in 90% of cases with pseudotumor cerebri and the absence of elevated intracranial pressure in all control subjects.

Conclusions

Elevated intracranial pressure produces a constellation of MR imaging signs that can assist in establishing the diagnosis of pseudotumor cerebri.

Section snippets

Materials and methods

We retrospectively reviewed the charts of all patients with pseudotumor cerebri who were examined between 1990 and 1997. The diagnosis of pseudotumor cerebri was established according to the following modification of the Dandy criteria5: (1) signs and symptoms of elevated intracranial pressure (including papilledema); (2) elevated opening pressure on lumbar puncture without CSF ab normalities; (3) normal neurologic examination (except for sixth nerve palsy); and (4) absence of ventriculomegaly

Results

Ages of patients with pseudotumor cerebri ranged from 3 to 66 years, with 16 adults (15 women, 1 man) and 4 children (3 girls, 1 boy). The condition was idiopathic in all but one child who was treated with a tapering dose of oral corticosteroids for Crohn’s disease.

Neuroimaging abnormalities in patients with pseudotumor cerebri are summarized in Table 1. Sensitivity and specificity values for each sign were determined statistically using Fisher’s two-tail exact test. Except for intraocular

Discussion

Until recently, attempts to use neuroimaging to elucidate the pathophysiology of pseudotumor cerebri have focused primarily on detecting abnormalities in ventricular size and periventricular water content.2, 6, 7, 8 Although increased periventricular water content7, 8 and a higher white matter diffusion coefficient9, 10 can be shown by quantitative analysis of cranial MR images, grossly visible changes usually are absent. Except for the findings of empty sella11, 12 and variable diminution in

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    Supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York.

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