Signs of Chronic Intracranial Hypertension on Magnetic Resonance Imaging Not Associated with Papilledema

While magnetic resonance imaging (MRI) signs of chronic intracranial hypertension are common for patients undergoing brain assessments, they are rarely associated with papilledema, according to a new study published in JAMA Neurology.

“Magnetic resonance imaging (MRI) signs of intracranial hypertension are traditionally associated with idiopathic intracranial hypertension, but these signs are also detected among individuals with primary headaches and among asymptomatic individuals without papilledema,” wrote Benson S Chen, MBChB, Emory University School of Medicine, Atlanta, Georgia, and co-investigators.

Researchers aimed to explore if there was an association between papilledema and prevalence of signs of intracranial hypertension detected through MRI brain scans.

A group of 296 patients undergoing brain MRI at one outpatient imaging facility were assessed between August 2019 and March 2020 in this cross-sectional study with ocular fundus photographs taken concurrently. Radiographic images were analyzed for MRI signs of intracranial hypertension.

The primary endpoint was prevalence of MRI signs of intracranial hypertension and prevalence of papilledema detected on ocular fundus photographs.

Radiographic signs of intracranial hypertension included empty sella, optic nerve head protrusion, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, enlarged Meckel caves, cephaloceles, cerebellar tonsillar descent, and bilateral transverse venous sinus stenosis.

Of 296 total patients, 49% of patients(n=145) had at least one MRI finding showing signs of chronic intracranial hypertension. Five patients, 1.7%, had detections of papilledema. Among patients with 4 or more MRI signs of intracranial hypertension, prevalence of papilledema increased to 40%.

The most common indication for MRI was surveillance of a brain neoplasm (n=82).

Each patient with papilledema had significantly higher body mass index than patients without, in addition to a history of idiopathic intracranial hypertension and an increased prevalence of empty sella, optic nerve tortuosity, and transverse venous sinus stenosis detected on MRI.

Signs of intracranial hypertension among patients undergoing brain MRI were common but rarely associated with papilledema.

A limitation of the study was early termination due to the COVID-19 pandemic.

“Further research is needed to determine which combination of MRI signs and clinical factors has the highest predictive value for papilledema, and such research would be useful to guide decision-making regarding patient selection for urgent assessments,” they concluded. —Erin McGuinness

Chen BS, Meyer BI, Saindane AM, Bruce BB, Newman NJ, Biousse V. Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema. JAMA Neurol. Published online April 19, 2021. doi:10.1001/jamaneurol.2021.0710