Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension

  • H. Wong
  • K. Sanghera
  • A. Neufeld
  • C. Maxner
  • Jai Jai Shiva ShankarEmail author
Diagnostic Neuroradiology



Although several studies have reported imaging findings associated with idiopathic intracranial hypertension (IIH), less is known about the correlation between imaging findings and IIH-related symptoms or signs. Our study aimed to determine if clinical features of IIH are correlated with magnetic resonance imaging (MRI) features.


A retrospective chart review was conducted on consecutive patients presenting at the neuro-ophthalmology department over the last 15 years. All patients diagnosed with IIH were identified and those with available MRI were included in the final analysis. All MRI images were reviewed by a neuroradiologist blinded to the presenting symptoms and signs. Statistical analysis was performed to determine the correlation between the MRI findings with each clinical symptom or sign.


Thirty-one out of 88 patients with the initial diagnosis of IIH had MRI available and were included in the study. Significant correlations were observed between colour vision and amount of perineural fluid around the optic nerve on MRI (r = − 0.382; p = 0.004), disc assessment and intraocular optic nerve protrusion (r = 0.364; p = 0.004), disc assessment and perineural fluid around the optic nerve (r = 0.276; p = 0.033) and disc assessment and venous sinus stenosis (r = 0.351; p = 0.009).


Our study highlights correlations between imaging and clinical findings of IIH. MRI findings in IIH may be useful in ruling out ominous causes of intracranial pressure and risk stratifying ophthalmologic intervention and management of patients with headaches possibly due to IIH.


Idiopathic intracranial hypertension Magnetic resonance imaging Retrospective chart review Cerebrospinal fluid 


Funding Information

No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wall M (2017) Update on idiopathic intracranial hypertension. Neurol Clin 35:45–57. CrossRefGoogle Scholar
  2. 2.
    Shaw AB, Sharma M, Shaikhouni A, Marlin ES, Ikeda DS, McGregor JM, Deogaonkar M (2015) Neuromodulation as a last resort option in the treatment of chronic daily headaches in patients with idiopathic intracranial hypertension. Neurol India 63:707–711. CrossRefGoogle Scholar
  3. 3.
    Best J, Silvestri G, Burton B, Foot B, Acheson J (2013) The incidence of blindness due to idiopathic intracranial hypertension in the UK. Open Ophthalmol J 7:26–29. CrossRefGoogle Scholar
  4. 4.
    McCluskey G, Doherty-Allan R, McCarron P, Loftus AM, McCarron LV, Mulholland D, McVerry F, McCarron MO (2018) Meta-analysis and systematic review of population-based epidemiological studies in idiopathic intracranial hypertension. Eur J Neurol 25:1218–1227. CrossRefGoogle Scholar
  5. 5.
    Wall M (2010) Idiopathic intracranial hypertension. Neurol Clin 28:593–617. CrossRefGoogle Scholar
  6. 6.
    Klein A, Stern N, Osher E, Kliper E, Kesler A (2013) Hyperandrogenism is associated with earlier age of onset of idiopathic intracranial hypertension in women. Curr Eye Res 38:972–976. CrossRefGoogle Scholar
  7. 7.
    Andrews LE, Liu GT, Ko MW (2014) Idiopathic intracranial hypertension and obesity. Horm Res Paediatr 81:217–225. CrossRefGoogle Scholar
  8. 8.
    Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165. CrossRefGoogle Scholar
  9. 9.
    Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, Krishnan A, Chavda SV, Ramalingam S, Edwards J, Hemmings K, Williamson M, Burdon MA, Hassan-Smith G, Digre K, Liu GT, Jensen RH, Sinclair AJ (2018) Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry 89:1088–1100. CrossRefGoogle Scholar
  10. 10.
    Vimont C (2016) All about the eye chart. Am Acad Ophthalmol Accessed 28 Jul 2019
  11. 11.
    Broadway DC (2012) How to test for a relative afferent pupillary defect (RAPD). Community Eye Health 25:58–59Google Scholar
  12. 12.
    Rauch K (2017) How color blindness is tested. Am Acad Ophthalmol Accessed 28 Jul 2019
  13. 13.
    Hingwala DR, Kesavadas C, Thomas B et al (2013) Imaging signs in idiopathic intracranial hypertension: are these signs seen in secondary intracranial hypertension too? Ann Indian Acad Neurol 16:229–233. CrossRefGoogle Scholar
  14. 14.
    Bialer OY, Rueda MP, Bruce BB, Newman NJ, Biousse V, Saindane AM (2014) Meningoceles in idiopathic intracranial hypertension. Am J Roentgenol 202:608–613. CrossRefGoogle Scholar
  15. 15.
    Degnan AJ, Levy LM (2011) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. Am J Neuroradiol 32:1986–1993. CrossRefGoogle Scholar
  16. 16.
    Desai PK Idiopathic intracranial hypertension | radiology reference article | In: Radiopaedia Accessed 28 Jul 2019
  17. 17.
    Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V (2015) Brain imaging in idiopathic intracranial hypertension. J Neuro-Ophthalmol 35:400–411. CrossRefGoogle Scholar
  18. 18.
    Maralani PJ, Hassanlou M, Torres C, Chakraborty S, Kingstone M, Patel V, Zackon D, Bussière M (2012) Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 67:656–663. CrossRefGoogle Scholar
  19. 19.
    Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A (2012) Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. AJNR Am J Neuroradiol 33:366–369. CrossRefGoogle Scholar
  20. 20.
    Morris PP, Black DF, Port J, Campeau N (2017) Transverse sinus stenosis is the most sensitive MR imaging correlate of idiopathic intracranial hypertension. AJNR Am J Neuroradiol 38:471–477. CrossRefGoogle Scholar
  21. 21.
    Sander K, Poppert H, Etgen T, Hemmer B, Sander D (2011) Dynamics of intracranial venous flow patterns in patients with idiopathic intracranial hypertension. Eur Neurol 66:334–338. CrossRefGoogle Scholar
  22. 22.
    Chan W, Neufeld A, Maxner C, Shankar J (2019) Irreversibility of transverse venous sinus stenosis and optic nerve edema post-lumbar puncture in idiopathic intracranial hypertension. Can J Ophthalmol 54:e57–e59. CrossRefGoogle Scholar
  23. 23.
    Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527. CrossRefGoogle Scholar
  24. 24.
    Acheson JF (2006) Idiopathic intracranial hypertension and visual function. Br Med Bull 79–80:233–244. CrossRefGoogle Scholar
  25. 25.
    Chang Y-CC, Alperin N, Bagci AM, Lee SH, Rosa PR, Giovanni G, Lam BL (2015) Relationship between optic nerve protrusion measured by OCT and MRI and papilledema severity. Invest Ophthalmol Vis Sci 56:2297–2302. CrossRefGoogle Scholar
  26. 26.
    Raja AS, Andruchow J, Zane R, Khorasani R, Schuur JD (2011) Use of neuroimaging in US emergency departments. Arch Intern Med 171:260–262. CrossRefGoogle Scholar
  27. 27.
    Komolafe MA, Komolafe EO, Olugbodi AA, Adeolu AA (2006) Which headache do we need to investigate? Cephalalgia Int J Headache 26:87–88. CrossRefGoogle Scholar
  28. 28.
    Razek AAKA, Batouty N, Fathy W, Bassiouny R (2018) Diffusion tensor imaging of the optic disc in idiopathic intracranial hypertension. Neuroradiology 60:1159–1166. CrossRefGoogle Scholar
  29. 29.
    Hoffmann J, Kreutz KM, Csapó-Schmidt C, Becker N, Kunte H, Fekonja LS, Jadan A, Wiener E (2019) The effect of CSF drain on the optic nerve in idiopathic intracranial hypertension. J Headache Pain 20:59. CrossRefGoogle Scholar
  30. 30.
    Sarica A, Curcio M, Rapisarda L, Cerasa A, Quattrone A, Bono F (2019) Periventricular white matter changes in idiopathic intracranial hypertension. Ann Clin Transl Neurol 6:233–242. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyDalhousie UniversityHalifaxCanada
  2. 2.Department of OphthalmologyUniversity of British ColumbiaVancouverCanada
  3. 3.Department of Ophthalmology and Visual SciencesDalhousie UniversityHalifaxCanada
  4. 4.Department of Radiology, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada

Personalised recommendations