The following is a summary of “MRI characteristics of idiopathic intracranial hypertension do not predict visual and headache outcomes,” published in the July 2023 issue of Pain by Bsteh et al.
Specific MRI findings assist in the diagnosis of people with idiopathic intracranial hypertension (IIH). In the retrospective study, researchers aimed to evaluate whether MRI characteristics predict visual and headache outcomes.
The study enrolled 84 (88.1% female, mean age 33.5 years, median body mass index 33.7) patients from the Vienna-Idiopathic-Intracranial-Hypertension (VIIH) database diagnosed with IIH based on Friedman criteria and having a diagnostic cranial MRI. They assessed features like empty sella (ES), perioptic subarachnoid space distension (POSD) with/without optic nerve tortuosity (ONT), posterior globe flattening (PGF), and transverse sinus stenosis (TSS). Using multivariable regression, they established models for visual outcomes (persistent visual impairment/visual worsening) and headache outcomes (headache improvement/freedom from headache).
The outcome resulted in 70.2% visual impairment, and 84.5% (54.8% chronic) had headache. In addition, 58.3% of patients suffered from persistent visual impairment, 13.1% visual got worse, 83.8% had headache improvement, and 26.2% reported relief from headaches. After examining MRI, one MRI feature was common in 78.6%. Around 60.0% had three or more features. The most common was POSD (64.3%), followed by TSS (60.0%), ONT (46.4%), ES (44.0%), and PGF (23.8%). According to multivariable models, no connection was found between MRI features or their number with visual impairment, visual worsening, headache improvement, or complete relief. They also predicted visual impairment at the start as ongoing vision problems (odds ratio 6.3, P<0.001), but persistent headaches predicted a lower chance of being completely headache-free (odds ratio 0.48, p=0.013) later on.
The study concluded that MRI characteristics of IIH do not predict visual or headache outcomes.