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Neuroimaging in the diagnosis and treatment of intracranial pressure disorders

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Abstract

Objective

To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension.

Methods

The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies.

Results

Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out.

Conclusions

Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.

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Abbreviations

IIH:

Idiopathic intracranial hypertension

SIH:

Spontaneous intracranial hypotension

CSF:

Cerebrospinal fluid

IIHWOP:

Idiopathic intracranial hypertension without papilledema

LP:

Lumbar puncture

MRI:

Magnetic resonance imaging

MRV:

MRI with venography

CT:

Computed tomography

CTM:

Computed tomography myelography

RIC:

Radioisotope cysternography

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  1. Department of Diagnostic Radiology, McGill University, Montreal, Canada

    Mauricio E. Moreno & Raquel Del Carpio – O’Donovan

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Moreno, M.E., Del Carpio – O’Donovan, R. Neuroimaging in the diagnosis and treatment of intracranial pressure disorders. Neurol Sci 44, 845–858 (2023). https://doi.org/10.1007/s10072-022-06478-x

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