Abstract:

Objective To study MRI features of patients with benign intracranial hypertension(BIH) presenting with ocular symptoms as a chief complaint. Design Retrospective case series. Participants Sixty-five patients with clinical definite benign intracranial hypertension. Methods The orbit or craniocerebral MRI and clinical data of 65 patients were analyzed retrospecticvely. The incidence of each possible MR imaging sign in this group of BIH with ocular symptoms were recorded and the differences among idiopathic intracranial hypertension (IIH), cerebral venous sinus thrombosis (CVST) and pleocytosis caused intracranial hypertension (ICH) were compared. MR imaging sign and fundus examination findings were also compared. Main Outcome Measures Presence or absence of special abnormal MR findings in the orbit or craniocerebral MRI. Results The MR imaging disclosed empty sella in 78.4% of patients with BIH, distension of the perioptic subarachnoid space in 74.1%, intraocular protrusion of the prelaminar optic nerve in 55.9%,vertical tortuosity of the orbital optic nerve in 37.3%, flattening of the posterior sclera in 34%, abnormality of thickness and signal intensity and enhancement of the optic nerve in 33.9%, and cerebellar tonsillar hernia in 7.7%. The incidence of distension of the perioptic subarachnoid space in IIH was significantly different from that of CVST and pleocytosis（χ2=10.161，P=0.001； χ2=6.065，P=0.014）. Sensitivity and specificity of MRI examination for papilledema was 52.8% and 58.3% respectively. Conclusions  Elevated intracranial pressure produced a constellation of MR imaging signs in orbit. Besides empty sella, distension of the perioptic subarachnoid space is the most common promising MRI finding that may suggest BIH. This sign may provide valuable clues for further etiological diagnosis. (Ophthalmol CHN, 2015, 24: 296-300)

Key words: intracranial hypertension, ocular symptom, magnetic resonance imaging