Abstract Details

Title Venous Manometry Insights: Diagnostic Criteria Utility and Clinical Correlation in Patients with Refractory Idiopathic Intracranial Hypertension

Topic Headache

Presentation(s) S20 - Hot Topics in Headache (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Background

TSS can be evaluated objectively by VM. However, how VM measurements correlate with IIH parameters and sensitivity/specificity of the 2013 (Friedman) and 2023 (modified Korsbaek; based on 2/3 signs: papilledema, OP ≥25 cmH2O, ≥3 imaging signs) IIH criteria remains unknown.

Objective

To investigate the clinical parameters of refractory idiopathic intracranial hypertension (rIIH) and sensitivity/specificity of IIH diagnostic criteria based on venous manometry (VM) confirmed transverse sinus stenosis (TSS).

Design/Methods

Patients with rIIH, no pertinent brain or spine surgery or secondary IIH, undergoing VM at Thomas Jefferson University Hospital between 01/2022 and 10/2023 were retrospectively evaluated for IIH parameters (e.g., lumbar puncture opening pressure [OP], body-mass index [BMI]), VM measurements (e.g., intravenous pressure [IVP] at torcula, internal jugular [IJ], and trans-stenotic pressure gradient [TSPG]), and 2013/2023 IIH diagnostic criteria. Patients who received venous sinus stenting (VSS) were also evaluated on the treatment responses.

Results

48 rIIH patients (age 38.9±9.9 years, BMI 36.8±9.1 kg/m2, all female) were identified and reviewed. VM confirmed 35 (72.9%) TSS patients (TSPG ≥8mmHg). The 2013 and 2023 criteria achieved sensitivity/specificity of 62.9%/30.8% and 85.7%/30.8%, respectively. Between TSS vs. non-TSS patients, there was no difference between OP (34±10.6 vs. 34.5±9.5, p=0.451) and BMI (38.0±8.4 vs. 36.3±8.5, p=0.601). No significant correlation (Pearson’s) was seen between BMI/OP vs. torcula (p=0.683/0.857), right TSPG (p=0.224/0.569), left TSPG (p=0.438/0.200), right IJ (p=0.051/0.792), and left IJ (p=0.265/0.564). BMI and OP were not correlated (p=0.297). Three months after VSS in TSS patients, improvement was seen in 25 (80.6%) with headaches, 19 (61.3%) with vision symptoms, and 18 (58.1%) with pulsatile tinnitus.

Conclusions

Compared to the 2013 criteria, the 2023 criteria appear more sensitive in identifying TSS in rIIH patients and are equally specific. IIH parameters, such as BMI and OP, may not directly reflect the underlying IVP or TSS. VSS may improve IIH symptoms, but long-term follow-up is needed.

Authors/Disclosures
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center) PRESENTER	An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH.
Areeba Nisar	No disclosure on file
Enchao Qiu (Jefferson Headache Center)	No disclosure on file
Isha P. Sharan	Miss Sharan has nothing to disclose.
Jenny Chan	Ms. Chan has nothing to disclose.
Nivethitha Arunkumar	Ms. Arunkumar has nothing to disclose.
Dagmar Beier	No disclosure on file
Rigmor Jensen	No disclosure on file
	No disclosure on file
Prabath Mondel (Thomas Jefferson University Hospital)	No disclosure on file
Neelu Jain	No disclosure on file
Kiran Talekar	No disclosure on file
Nicole M. Spare, DO (Jefferson Headache Center)	Dr. Spare has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.
Simy K. Parikh, MD (Jefferson Hospital For Neuroscience Headache Center)	Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Parikh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Touch Independent Medical Education (touchIME) . Dr. Parikh has a non-compensated relationship as a Medical Advisory Board Member with Spinal CSF Leak Foundation that is relevant to AAN interests or activities.
Syed Omar Shah, MD	Dr. Shah has nothing to disclose.
Michael J. Marmura, MD, FAAN (Thomas Jefferson University)	Dr. Marmura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axsome. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Marmura has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Marmura has stock in Curelator. The institution of Dr. Marmura has received research support from Teva. The institution of Dr. Marmura has received research support from AbbVie. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care.
Mark L. Moster, MD, FAAN (Neuro-Ophthalmology -Wills Eye Hospital)	Dr. Moster has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Gensight . Dr. Moster has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viridian. Dr. Moster has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Kilcoyne and Nesbitt.
James Evans	No disclosure on file
Reid Gooch	No disclosure on file