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Images in Neurology
March 7, 2022

Reversal of Imaging Findings of Idiopathic Intracranial Hypertension After Lumbar Puncture

Author Affiliations
  • 1Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 2Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
JAMA Neurol. 2022;79(4):416-417. doi:10.1001/jamaneurol.2022.0085

Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure (ICP) with no identifiable underlying cause. The condition predominantly affects women aged 20 to 40 years and is strongly associated with obesity.1 Most patients present with a disabling headache that has a risk for permanent vision loss in up to 25% of cases.1 Diagnosis of IIH requires a combination of clinical and imaging criteria, including a combination of papilledema, normal neurologic examination findings (except sixth nerve abnormality), neuroimaging features, normal cerebrospinal fluid (CSF) composition, and elevated opening pressure (≥250 mm). A number of neuroimaging features are described, including empty sella, flattening of the posterior aspect of the globe, distention of the perioptic subarachnoid space, and transverse sinus stenosis.1 The cause of IIH remains unclear but is thought to be related to disordered CSF regulation, with potential CSF hypersecretion and/or reduced drainage. There are a number of management strategies that have been adopted for the management of IIH, including weight loss, pharmacotherapy, lumbar puncture, optic nerve sheath fenestration, CSF shunting, and transverse sinus stenting.

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