Open Access Open Access  Restricted Access Subscription or Fee Access

Clinicoradiological Evaluation of Idiopathic Intracranial Hypertension

Praveen Kumar Yadav, Ashwini Kumar Panda

Abstract


Idiopathic intracranial hypertension refers to elevated intracranial pressure when there is no detectable space-occupying lesion. Individuals with idiopathic intracranial hypertension commonly exhibit classic indications of increased intracranial pressure, including headaches, nausea, neck discomfort, double vision, temporary visual obscurity, and swelling of the optic nerve head (papilledema). Typical magnetic resonance imaging findings include empty sella, optic nerve tortuousity, globe flattening, and transverse sinus stenosis. All patients from July 2021 to June 2022 presented to the super speciality neurology clinic with symptoms suggestive of idiopathic intracranial hypertension were included in the present study after consent. Clinical pattern and magnetic resonance imaging brain findings along with other risk factors and comorbidities were studied. A total of 12 patients were studied; out of which all were female. The most common age group studied was 31–34 years (41.6%). The predominant clinical manifestations included headaches and episodes of Transient Visual Obscurations, followed by painless vision loss, alterations in the visual field, and double vision. About seven out of 12 cases presented with headache (58.3%); out of which only three were suffering from migraine. Transient Visual Obscuration was presenting complain of seven patients (58.3%). Painless visual loss was found in three patients (25%), out of which only one case was bilateral (33%). In all cases (100%), magnetic resonance imaging was suggestive of idiopathic intracranial hypertension. Transverse Sinus Stenosis and scleral flattening was seen in three cases (25%) and one case (14.2%), respectively. The present study concluded that clinical suspicion followed by magnetic resonance imaging brain is of utmost importance. Swift identification and intervention are crucial in individuals with idiopathic intracranial hypertension to avert enduring vision impairment.

Keywords


Headache, idiopathic intracranial hypertension, visual obscurations, neck pain, double vision, painless loss of vision, magnetic resonance imaging findings, clinical presentations.

Full Text:

PDF

References


Hoffmann J, Mollan SP, Paemeleire K, Lampl C, Jensen RH, Sinclair AJ. European headache federation guideline on idiopathic intracranial hypertension. J Headache Pain. 2018; 19(1): 93p. doi: 10.1186/s10194–018–0919–2. PMID: 30298346; PMCID: PMC6755569.

Mollan SP, Ali F, Hassan-Smith G, Botfield H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016; 87(9): 982–992p.

Westgate CSJ, Israelsen IME, Jensen RH, Eftekhari S. Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension. J Headache Pain. 2021; 22(1): 123p. doi: 10.1186/s10194–021–01337–0. PMID: 34629054; PMCID: PMC8504002.

Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of Idiopathic Intracranial Hypertension. Eye. 2018; 33: 478–485p.

Adderley NJ, Subramanian A, Nirantharakumar K, Yiangou A, Gokhale KM, Mollan SP, Sinclair AJ. Association Between Idiopathic Intracranial Hypertension and Risk of Cardiovascular Diseases in Women in the United Kingdom. JAMA Neurol. 76(9): 1088–1098p. Epubaheadofprint8JuLy2019.DOI:https://doi.org/10.1001/jamaneurol.2019.1812

Takkar A, Lal V. Idiopathic Intracranial Hypertension: The Monster Within. Ann Indian Acad Neurol. 2020; 23(2): 159–166p. doi: 10.4103/aian.AIAN_190_19. Epub 2020 Feb 25. PMID: 32189855; PMCID: PMC7061511

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed., vol 38. Cephalalgia. 2018; 38(1): 1–211p.

Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013; 81(13): 1159–1165p.

Achmed Pircher, Montali M, Jatta Berberat, Huber A, Miller NR, Mader TH, et al. Elevated perioptic lipocalin-type prostaglandin D synthase concentration in patients with idiopathic intracranial hypertension. Brain Communications. Sep 2022; 4(5): fcac240. Online Available from: https://academic.oup.com/braincomms/article/4/5/fcac240/6717955

Pircher A, Montali M, Berberat J, Huber A, Miller NR, Mader TH, Gibson CR, Neutzner A, Remonda L, Killer HE. Elevated perioptic lipocalin-type prostaglandin D synthase concentration in patients with idiopathic intracranial hypertension. Brain Communications. 2022; 4(5): 240p. Available from: https://academic.oup.com/braincomms/article/4/5/fcac240/6717955 Neurology Jul 2014, 83 (2) 198–200; DOI:10.1212/01.wnl.0000452039.32455.3e [cited 2023 Oct 5]

Ray S, Takkar A, Lal V. Idiopathic Intracranial Hypertension- The Eyes and Beyond. Ann Indian Acad Neurol. 2022; 25(2): 179–180p. doi: 10.4103/aian.aian_847_21. Epub 2022 Feb 9. PMID: 35693645; PMCID: PMC9175430.

Prabhat N, Chandel S, Takkar DA, Ahuja C, Singh R, Kathirvel S, Lal V. Sensitivity and specificity of neuroimaging signs in patients with idiopathic intracranial hypertension. Neuroradiol J. 2021; 34: 421–427p.

Cello KE, Keltner JL, Johnson CA, Wall M, NORDIC Idiopathic Intracranial Hypertension Study Group. Factors affecting visual field outcomes in the idiopathic intracranial hypertension treatment trial. J Neuroophthalmol. 2016; 36: 6–12p.

Hoffmann J, Schmidt C, Kunte H, Klingebiel R, Harms L, Huppertz HJ, Ludemann L, Wiener E. Volumetric assessment of optic nerve sheath and Hypophysis in idiopathic intracranial hypertension. AJNR Am J Neuroradiol. 2014; 35(3): 513–518p.

Degnan AJ, Levy LM. Narrowing of Meckel's cave and cavernous sinus and enlargement of the optic nerve sheath in Pseudotumor Cerebri. J Comput Assist Tomogr. 2011; 35(2): 308–312p.

Hoffmann J, Huppertz HJ, Schmidt C, Kunte H, Harms L, Klingebiel R, Wiener E. Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia. 2013; 33(13): 1075–1084p.

Agid R, Farb R, Willinsky R, Mikulis D, Tomlinson G. Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology. 2006; 48(8): 521–527p [PubMed: 16703359]. 18. Degnan AJ, Levy LM. Pseudotumor Cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol. 2011; 32(11): 1986–1993p.

Mulla Y, Markey KA, Woolley RL, Patel S, Mollan SP, Sinclair AJ. Headache determines quality of life in idiopathic intracranial hypertension. J Headache Pain. 2015; 16: 521p.

Mollan SP, Grech O, Sinclair AJ. Headache attributed to idiopathic intracranial hypertension and persistent post-idiopathic intracranial hypertension headache: A narrative review. Headache J Head Face Pain. 2021; 61: 808–816p.

© STM Journals 2023. All Rights Reserved 45

Pircher A, Montali M, Berberat J, Huber A, Miller NR, Mader TH, Gibson CR, Neutzner A, Remonda L, Killer HE. Elevated perioptic lipocalin-type prostaglandin D synthase concentration in patients with idiopathic intracranial hypertension. Brain Communications. 2022; 4(5): 8p. Available from: https://doi.org/10.1093/braincomms/fcac240

Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain J Neurol. 1991; 114: 155–180p.

Nicholson P, Kedra A, Shotar E, Bonnin S, Boch AL, Shor N, Clarençon F, Touitou V, Lenck S. Idiopathic Intracranial Hypertension: Glymphedema of the Brain. J Neuroophthalmol. 2021; 41(1): 93–97p. doi: 10.1097/WNO.0000000000001000. PMID: 33034442.

Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, Krishnan A, Chavda SV, Ramalingam S, Edwards J, Hemmings K, Williamson M, Burdon MA, Hassan-Smith G. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry. 2018; 89: 1088–1100p.

Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP; NORDIC Idiopathic Intracranial Hypertension Study Group. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol. 2014; 71(6): 693–701p. doi: 10.1001/jamaneurol.2014.133. PMID: 24756302; PMCID: PMC4351808.

Chen J, Wall M. Epidemiology and risk factors for idiopathic intracranial hypertension. Int Ophthalmol Clin. 2014; 54(1): 1–11p. doi: 10.1097/IIO.0b013e3182aabf11. PMID: 24296367; PMCID: PMC3864361.

Barkatullah AF, Leishangthem L, Moss HE. MRI findings as markers of idiopathic intracranial hypertension. Curr Opin Neurol. 2021; 34(1): 75–83p. doi:10.1097/WCO.0000000000000885.

Passi N, Degnan A, Levy L. MR Imaging of Papilledema and Visual Pathways: Effects of Increased Intracranial Pressure and Pathophysiologic Mechanisms. American Journal of Neuroradiology. 2012; 34(5): 919–924p.




DOI: https://doi.org/10.37591/rrjon.v13i2.3271

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023 Research & Reviews: Journal of Neuroscience