Magnetic Resonance Imaging Findings of Elevated Intracranial Pressure in Cerebral Venous Thrombosis Versus Idiopathic Intracranial Hypertension with Transverse Sinus Stenosis

ABSTRACT

We wished to determine whether magnetic resonance imaging signs suggesting elevated intracranial pressure are more frequently found in patients with idiopathic intracranial hypertension (IIH) than in those with cerebral venous thrombosis (CVT). Among 240 patients who underwent standardised contrast-enhanced brain magnetic resonance brain imaging and venography at our institution between September 2009 and September 2011, 60 with abnormal imaging findings on magnetic resonance venography were included: 27 patients with definite and 2 patients with presumed idiopathic intracranial hypertension, and 31 with definite cerebral venous thrombosis. Medical records were reviewed, and imaging studies were prospectively evaluated by the same neuroradiologist to assess for presence or absence of transverse sinus stenosis, site of cerebral venous thrombosis if present, posterior globe flattening, optic nerve sheath dilation/tortuosity, and the size/appearance of the sella turcica. Twenty-nine patients with idiopathic intracranial hypertension (28 women, 19 black, median age: 28, median body mass index: 34  kg/m²) had bilateral transverse sinus stenosis. Thirty-one CVT patients (19 women, 13 black, median age: 46, median body mass index: 29) had thrombosis of the sagittal (3), sigmoid (3), cavernous (1), unilateral transverse (7), or multiple (16) sinuses or cortical veins (1). Empty/partially empty sellae were more common in IIH (3/29 and 24/29) than in cerebral venous thrombosis patients (1/31 and 19/31) (p < 0.001). Flattening of the globes and dilation/tortuosity of the optic nerve sheaths were more common in idiopathic intracranial hypertension (20/29 and 18/29) than in cerebral venous thrombosis (13/31 and 5/31) (p < 0.04). We conclude that although abnormal imaging findings suggestive of raised intracranial pressure are more common in IIH, they are not specific for that disorder and are found in patients with raised intracranial pressure from other causes such as cerebral venous thrombosis.

• Cerebral venous thrombosis
• empty sella
• idiopathic intracranial hypertension
• MRI
• MRV
• venous hypertension

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by National Insitutes of Health/National Eye Institute (NIH/NEI) core grant P30-EY06360 (Department of Ophthalmology). Dr. Bruce receives research support from the NIH/NEI (K23-EY019341). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.