, Volume 48, Issue 8, pp 521–527 | Cite as

Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs

  • R. AgidEmail author
  • R. I. Farb
  • R. A. Willinsky
  • D. J. Mikulis
  • G. Tomlinson
Diagnostic Neuroradiology


The aim of this study was to evaluate the accuracy of previously reported neuroimaging signs in establishing or excluding the diagnosis of idiopathic intracranial hypertension (IIH). In a retrospective study, 30 patients with confirmed IIH and 56 controls were evaluated with brain magnetic resonance imaging. All examinations were evaluated in a blinded fashion by three neuroradiologists for the presence or absence of the ‘traditional’ signs of IIH: empty sella turcica, deformation of the pituitary, slit-like ventricles, ‘tight’ subarachnoid spaces, flattening of the posterior globe, protrusion of the optic nerve, enhancement of the optic nerve head, distension of the optic nerve sheath and vertical tortuosity of the optic nerve. Optic nerve protrusion and enhancement, slit-like ventricles and tight cerebrospinal fluid spaces were not significantly associated with IIH (P>0.05). Posterior globe flattening, optic nerve sheath distension, optic nerve tortuosity, pituitary deformity and empty sella turcica were significantly associated with IIH (P<0.05). However, most of these are not helpful in a clinical setting, with the exception of posterior globe flattening. This is the only sign that, if present, strongly suggests the diagnosis of IIH (specificity 100%, 95% CI 93.6% to 100%; sensitivity 43.5%, 95% CI 27.3% to 60.8%; positive likelihood ratio 49.7). The majority of the reported signs for IIH on cross-sectional imaging are not helpful in establishing or excluding the diagnosis of IIH, and are of no value in the clinical setting. Flattening of the posterior aspect of the globe is the only sign that, if present, is suggestive of the diagnosis of IIH.


Idiopathic intracranial hypertension Neuroimaging signs 


Conflict of interest statement

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • R. Agid
    • 1
    Email author
  • R. I. Farb
    • 1
  • R. A. Willinsky
    • 1
  • D. J. Mikulis
    • 1
  • G. Tomlinson
    • 1
  1. 1.Division of Neuroradiology, Department of Medical ImagingToronto Western HospitalTorontoCanada

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