Neurological

Signs of intracranial hypertension on MRI that are not often associated with papilledema

Signs of intracranial hypertension are common in patients who have magnetic resonance imaging (MRI) of the brain; However, according to study results published in JAMA Neurology, the prevalence of papilledema is rare.

A team of researchers conducted a prospective cross-sectional study to determine the frequency of signs of intracranial hypertension in adult outpatients undergoing MRI and whether these symptoms were associated with papillary edema.

After MRI, patients underwent bilateral non-mydriatic fundus photography and examined for headache, visual symptoms, and ocular history. The primary endpoints were the prevalence of MRI-detected signs of intracranial hypertension and the prevalence of papillary edema as confirmed by fundus photos.

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Patients received type 1 sagittal weighted and axial type 2 weighted imaging, and patients who received contrast MRI received 0.2 ml / kg body weight intravenous gadolinium-based contrast prior to type 1 contrast-enhanced type 1 weighted imaging.

Of the 388 patients screened, 296 patients (mean age 49.5 years; 63.5% women) were able to take part in the study. Brain neoplasms were the most common indication for MRI (27.7%), followed by investigation of neurological symptoms without headache (19.6%) and diagnosis or monitoring of multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocytes -Glycoprotein-associated diseases (18.9%).

MRI signs of intracranial hypertension included empty sella, bulging of the optic nerve head, flattening of the posterior sclera, increased perioptic fluid (CSF), tortuosity of the optic nerve, enlarged Meckel’s sinuses, cephaloceles, cerebellar tonsil descent, and bilateral transverse veins sinus stenosis.

At least 1 sign was present in 49.0% of the patients: 33.1% of the patients had an empty sella, 15.9% of the patients had enlarged Meckel’s cavities, 10.8% of the patients had an increased perioptic CSF, 7.8% of patients had optic nerve tortuosity, 1.4% of patients had cephaloceles, and 0.7% of patients had scleral flattening. Of the 198 patients who received contrast media, 3.0% of the patients had bilateral transverse sinus stenosis.

On fundus photography, only 5 patients had papillary edema; Two patients had a history of idiopathic intracranial hypertension and worsening headache, 2 patients had glioblastoma, and 1 patient had a history of temporal lobe seizures as a result of meningoencephalocele.

Compared to patients with at least 1 sign of MRI-detected intracranial hypertension, the prevalence of papilledema increased from 2.8% to 40.0% in patients with 4 or more signs.

“In patients with incidental MRI signs of IH, an immediate clinical examination for signs and symptoms of IH, including an ocular fundus examination, is preferable to a systematic lumbar puncture,” the study shows. “More research is needed to determine which combination of MRI signs and clinical factors has the highest predictive value of papilledema, and this research would be useful to guide decision-making regarding patient selection for urgent assessments,” the researchers concluded.

Disclosure: A study author stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.

reference

Chen BS, Meyer BI, Saindane AM, et al. Prevalence of incidentally discovered signs of intracranial hypertension on magnetic resonance imaging and its association with papillary edema. JAMA Neurol. Published online April 19, 2021. doi: 10.1001 / jamaneurol.2021.0710

This article originally appeared on Ophthalmology Advisor

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