Neuroimaging Findings in Patients with Idiopathic Intracranial Hypertension after Treatment

Abstract

Objective: Few reports have investigating the reversal of neuroimaging findings of idiopathic intracranial hypertension (IIH). Our study aimed to show to what extent these findings are reversible after treatment. Materials and Methods: Eight patients with magnetic resonance imaging (MRI) findings who were followed-up in the University of Health Sciences Turkey, Antalya Training and Research Hospital Headache Outpatient Clinic and diagnosed as having IIH between 2017 and 2019 were included in the study. Demographic characteristics of the patients, body mass indexes (BMI), duration of treatment, the timing of MRI taken after treatment, and MRI before and after treatment were recorded. The sellar configurations were measured on midsagittal T1 images and the height of the midsagittal pituitary gland was measured on T1 or T2 sagittal images. Optic nerve (ON) thickness was measured from T2 axial sections in brain MRI. The Globus configuration was evaluated using diffusion-weighted imaging (DWI) for ON hyperintensity using axial FLAIR images. ON tortuosity was evaluated in T2 images of horizontal sections. Results: The mean age was 36 [minimum (min): 22, maximum (max): 45] years, the average BMI was 31.8±2.8. All patients were women. Post-treatment MRI was performed after an average of 5.5 (min: 3, max: 10) months later. After the treatment, a partial sella image was detected in one patient with empty sella, and empty sella was observed in one patient with partial sella. The mid sagittal pituitary gland height decreased after treatment in all patients except one. ON thickness improved for both eyes (right eye p=0.041, left eye p=0.012). The Globus configuration before and after treatment was the same in all patients. The ON tortiosity improved in one patient, and became clear in one patient. The ON hyperintensity observed in DWI persisted in all patients. Conclusion: Despite the small sample size, this study showed that many of these MRI findings are somewhat reversible after treatment.

Keywords

• idiopathic intracranial hypertension
• pseudotumor cerebri
• neuroimaging findings