Abstract Details

Title Significance of Incidental Signs of Raised Intracranial Pressure on Magnetic Resonance Imaging: A Prospective Study with Concurrent Fundus Photography

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) Neuro-ophthalmology/Neuro-otology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 007

Background MRI signs suggesting intracranial hypertension are common in patients with idiopathic intracranial hypertension (IIH), but are also incidentally detected in asymptomatic patients and those with primary headache syndromes, prompting neuro-ophthalmology consultations and investigations.

Objective To prospectively identify the prevalence and significance of MRI signs of intracranial hypertension (MRI-IH) in patients imaged for any clinical indication.

Design/Methods

Consecutive patients undergoing outpatient brain MRI completed concurrent non-mydriatic fundus photography immediately following MRI. Photographs were reviewed for papilledema and MRIs read for MRI-IH. Univariate analysis with Fisher’s exact test or t-test was performed.

Results Two hundred and ninety-six consecutive MRI were completed for brain neoplasm (27.7%), multiple sclerosis (MS) and MS-mimics (18.6%), seizure (17.9%), headache (8.8%), and other non-headache neurologic symptoms (19.6%). Four patients (1.4%) had known IIH. MRI-IH (n, %) included: empty sella (98, 33.1%); enlarged Meckel cave (47, 15.9%); meningocele/cephalocele (4, 1.4%); transverse venous sinus stenosis (TSS) (7/198, 3.6%); scleral flattening (2, 0.7%); increased perioptic CSF (32, 10.8%); and increased optic nerve tortuosity (23, 7.8%). Overall, 51% patients exhibited no MRI-IH, 32.8% one sign, 10.8% two signs, 3.7% three signs, and 1.7% had ≥four signs. Five patients (1.7%) had definite papilledema on fundus photographs; two (0.7%) had questionable papilledema. Patients with definite papilledema had significantly increased average BMI (37.6 vs 27.5 kg/m²; P=0.038), history of IIH (40% vs 1%; P=0.001), increased optic nerve tortuosity (60% vs 7%; P=0.004), TSS (50% vs 3%; P=0.006), and ≥four MRI-IH (40% vs 1%; P=0.002), compared to patients without papilledema. Other MRI-IH were not significant, nor were having one, two, or three signs.

Conclusions

MRI-IH were encountered in almost half the patients in this prospective study of outpatients undergoing brain MRI for various clinical indications. However, definite papilledema was only detected in 1.7% patients, questioning the need to perform systematic investigations for patients with incidentally detected MRI-IH.

Authors/Disclosures
Benson Chen, MBChB (Gonville and Caius College) PRESENTER	Dr. Chen has nothing to disclose.
Benjamin Meyer	Mr. Meyer has nothing to disclose.
Amit Saindane	No disclosure on file
Beau B. Bruce, MD, FAAN (Centers for Disease Control & Prevention)	Dr. Bruce has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Bayer.
Nancy J. Newman, MD, FAAN (Emory University School of Medicine)	Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophth. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Chiesi/Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD	Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $0-$499 for serving as a Consultant for Neurophoenix. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.