Abstract
Background
Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children.
Methods
In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests.
Results
In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference (P < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group (P < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups (P < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH.
Conclusion
The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity.
Similar content being viewed by others
Availability of data and materials
The data that support the findings of this study are available on reasonable request from the corresponding author.
References
Saria MG, Kesari S (2021) Increased Intracranial Pressure: The Use of an Individualized Ladder Approach. Semin Oncol Nurs 37(2):151133. WB Saunders
Chen J, Wall M (2014) Epidemiology and risk factors for idiopathic intracranial hypertension. Int Ophthalmol Clin 54(1):1–1
Rehder D (2020) Idiopathic intracranial hypertension: review of clinical syndrome, imaging findings, and treatment. Curr Probl Diagn Radiol 49(3):205–214
Radhakrishnan K, Ahlskog JE, Garrity JA, Kurland LT (1994) Idiopathic intracranial hypertension. Mayo Clin Proc 69(2):169–180. Elsevier
Cleves-Bayon C (2018) Idiopathic intracranial hypertension in children and adolescents: an update. Headache J Head Face Pain 58(3):485–93
Kanagalingam S, Subramanian PS (2015) Cerebral venous sinus stenting for pseudotumor cerebri: a review. Saudi J Ophthalmol 29(1):3–8
Biousse V (2012) Idiopathic intracranial hypertension: diagnosis, monitoring and treatment. Revue Neurol 168(10):673–683
Julayanont P, Karukote A, Ruthirago D, Panikkath D, Panikkath R (2016) Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res 87–99
Wall M et al (2014) The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 71(6):693–701. https://doi.org/10.1001/jamaneurol.2014.133
Albakr A, Hamad MH, Alwadei AH, Bashiri FA, Hassan HH, Idris H et al (2016) Idiopathic intracranial hypertension in children: diagnostic and management approach. Sudan J Paediatr 16(2):67
Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81(13):1159–1165
Barkatullah AF, Leishangthem L, Moss HE (2021) MRI findings as markers of idiopathic intracranial hypertension. Curr Opin Neurol 34(1):75
Lim MJ, Pushparajah K, Jan W, Calver D, Lin J-P (2010) Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 25(3):294–299
Vaghela V, Hingwala DR, Kapilamoorthy TR, Kesavadas C, Thomas B (2011) Spontaneous intracranial hypo and hypertensions: an imaging review. Neurol India 59(4):506
Kwee RM, Kwee TC (2019) Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension. Eur J Radiol 116:106–115
Kuzan BN, Ilgın C, Kuzan TY, Dericioğlu V, Kahraman-Koytak P, Uluç K et al (2022) Accuracy and reliability of magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension. Eur J Radiol 155:110491
Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59(10):1492–1495
Morris P, Black D, Port J, Campeau N (2017) Transverse sinus stenosis is the most sensitive MR imaging correlate of idiopathic intracranial hypertension. Am J Neuroradiol 38(3):471–477
Farb R, Vanek I, Scott J, Mikulis D, Willinsky R, Tomlinson G (2003) Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60(9):1418–1424
Geeraerts T, Newcombe VF, Coles JP, Abate MG, Perkes IE, Hutchinson PJ et al (2008) Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 12(5):1–7
Alperin N, Bagci A, Lam B, Sklar E (2013) Automated quantitation of the posterior scleral flattening and optic nerve protrusion by MRI in idiopathic intracranial hypertension. Am J Neuroradiol 34(12):2354–2359
Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V (2015) Brain imaging in idiopathic intracranial hypertension. J Neuroophthalmol 35(4):400–411
Saindane AM, Lim PP, Aiken A, Chen Z, Hudgins PA (2013) Factors determining the clinical significance of an “empty” sella turcica. Am J Roentgenol 200(5):1125–1131
Yuh WT, Zhu M, Taoka T, Quets JP, Maley JE, Muhonen MG et al (2000) MR imaging of pituitary morphology in idiopathic intracranial hypertension. J Magn Reson Imaging 12(6):808–813
Scott RA, Tarver WJ, Brunstetter TJ, Urquieta E (2020) Optic nerve tortuosity on earth and in space. Aerosp Med Hum Perform 91(2):91–97
Levene MI (1981) Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child 56(12):900–904
Whitelaw A, Aquilina K (2012) Management of posthaemorrhagic ventricular dilatation. Arch Dis Child Fetal Neonatal Ed 97(3):F229–F233
Barr AN, Heinze WJ, Dobben GD, Valvassori GE, Sugar O (1978) Bicaudate index in computerized tomography of Huntington disease and cerebral atrophy. Neurology 28(11):1196
Friedman DI (2014) The pseudotumor cerebri syndrome. Neurol Clin 32(2):363–396
Babikian P, Corbett J, Bell W (1994) Idiopathic intracranial hypertension in children: the Iowa experience. J Child Neurol 9(2):144–149
Gordon K (1997) Pediatric pseudotumor cerebri: descriptive epidemiology. Can J Neurol Sci 24(3):219–221
Malem A, Sheth T, Muthusamy B (2021) Paediatric idiopathic intracranial hypertension (IIH)—a review. Life 11(7):632
Hirfanoglu T, Aydin K, Serdaroglu A, Havali C (2015) Novel magnetic resonance imaging findings in children with intracranial hypertension. Pediatr Neurol 53(2):151–156
Gilbert AL, Vaughn J, Whitecross S, Robson CD, Zurakowski D, Heidary G (2021) Magnetic resonance imaging features and clinical findings in pediatric idiopathic intracranial hypertension: a case–control study. Life 11(6):487
Kılıç B, Güngör S (2021) Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension. Acta Neurol Belg 121:1567–1573
Hartmann AJ, Soares BP, Bruce BB, Saindane AM, Newman NJ, Biousse V et al (2017) Imaging features of idiopathic intracranial hypertension in children. J Child Neurol 32(1):120–126
Gilbert AL, Vaughn J, Robson C, Whitecross S, Heidary G (2016) Radiographic features in pediatric idiopathic intracranial hypertension. J Am Assoc Pediatr Ophthalmol Strabismus JAAPOS 20(4):e16
Rangwala LM, Liu GT (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52(6):597–617
Aylward SC, Way AL (2018) Pediatric intracranial hypertension: a current literature review. Curr Pain Headache Rep 22:1–9
Aylward SC (2013) Pediatric idiopathic intracranial hypertension: a need for clarification. Pediatr Neurol 49(5):303–304
Ahmad SR, Moss HE (2019) Update on the diagnosis and treatment of idiopathic intracranial hypertension. Semin Neurol 39(06):682–691. Thieme Medical Publishers
Takkar A, Lal V (2020) Idiopathic intracranial hypertension: the monster within. Ann Indian Acad Neurol 23(2):159
Karamimagham S, Poursadeghfard M, Hemmati F (2017) Normal reference range of lateral ventricle parameters in preterm neonates by ultrasonography. Shiraz E-Med J 18(8)
Esiri MM (2007) Ageing and the brain. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland 211(2):181–187
Lee JH, Yoon S, Renshaw PF, Kim T-S, Jung JJ, Choi Y et al (2013) Morphometric changes in lateral ventricles of patients with recent-onset type 2 diabetes mellitus. PLoS ONE 8(4):e60515
Taşcioğlu T (2022) The diagnostic value of cranial MRI findings in idiopathic intracranial hypertension: evaluating radiological parameters associated with intracranial pressure. Acta Radiol 63(10):1390–1397
Beizaei B, Toosi FS, Shahmoradi Y, Akhondian J, Ashrafzadeh F, Toosi MB, Imannezhad S, Kooshki A, Nejad EH, Payandeh A, Tavakkolizadeh N, Ghalibaf AM, Hashemi N (2024) Correlation between Diagnostic Magnetic Resonance Imaging Criteria and Cerebrospinal Fluid Pressure in Pediatric Idiopathic Intracranial Hypertension. Ann Child Neurol 32(1):1–7
Maralani P, Hassanlou M, Torres C, Chakraborty S, Kingstone M, Patel V et al (2012) Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 67(7):656–663
Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B (2011) Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 37:1059–1068
Hansen H-C, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87(1):34–40
Wang L-J, Yao Y, Feng L-S, Wang Y-Z, Zheng N-N, Feng J-C et al (2017) Noninvasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter. Sci Rep 7(1):42063
Kim DH, Jun J-S, Kim R (2018) Measurement of the optic nerve sheath diameter with magnetic resonance imaging and its association with eyeball diameter in healthy adults. J Clin Neurol 14(3):345–350
Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15(2):201–204
Janthanimi P, Dumrongpisutikul N (2019) Pediatric optic nerve and optic nerve sheath diameter on magnetic resonance imaging. Pediatr Radiol 49:1071–1077
Amini A, Kariman H, Dolatabadi AA, Hatamabadi HR, Derakhshanfar H, Mansouri B et al (2013) Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med 31(1):236–239
Trevethan R (2017) Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health 5:307
Author information
Authors and Affiliations
Contributions
F.S., N.H., and B.B. designed the study; F.S., N.H., B.B., E.H., F.A., M.B., and J.A. performed experiments; E.H., B.B., A.P., M.E., and N.T. collected and analyzed data; N.H., B.B., N.T., A.P., and E.H. performed the statistical analysis; B.B., E.H., N.T., A.P., Y.S., M.P., A.M., and S.A.K. wrote the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Seilanian Toosi, F., Hashemi, N., Emadzadeh, M. et al. The diagnostic value of MRI findings in pediatric idiopathic intracranial hypertension: a case-control study. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06354-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00381-024-06354-3