Distinctive MRI findings and clinical correlations in pediatric idiopathic intracranial hypertension: optic nerve sheath dilatation and scleral flattening as diagnostic indicators

Abstract

Background

Idiopathic intracranial hypertension (IIH) in the pediatric population is a rare disease, and imaging is important in its diagnostic criteria.

Purpose

To elucidate distinctive magnetic resonance imaging (MRI) findings of pediatric IIH and their correlation with clinical manifestations.

Material and Methods

A total of 41 pediatric patients diagnosed with IIH and a control group consisting of 40 healthy children were retrospectively analyzed. Clinical parameters (body mass index, papilledema, cerebrospinal fluid [CSF] pressure), visual acuity, visual fields, and MRI findings were assessed. Statistical analysis was performed using SPSS 21.0 software.

Results

The mean age was 12.4 ± 3.4 years, with 78% presenting with headaches and 24% with nausea and/or vomiting. MRI findings revealed optic nerve sheath dilatation (51.2%), posterior scleral flattening (43.9%), optic nerve tortuosity (19.5%), pituitary flattening (34.1%), and optic disc bulging (29.3%). Optic nerve sheath dilatation correlated with high CSF pressure. Scleral flattening correlated with elevated intracranial pressure, papilledema, and visual field defects. Optic disc bulging correlated with elevated papilledema and visual field defects also.

Conclusion

This study highlights the diagnostic significance of optic nerve sheath dilatation and scleral flattening in pediatric IIH. Scleral flattening may be an important marker for optic nerve damage.