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Reversal of Imaging Findings of Idiopathic Intracranial Hypertension After Lumbar Puncture

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To identify the key insights or developments described in this article
1 Credit CME

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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Anish Kapadia, MD, Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (anish.kapadia@mail.utoronto.ca).

Published Online: March 7, 2022. doi:10.1001/jamaneurol.2022.0085

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Mollan  SP , Davies  B , Silver  NC ,  et al.  Idiopathic intracranial hypertension: consensus guidelines on management.   J Neurol Neurosurg Psychiatry. 2018;89(10):1088-1100. doi:10.1136/jnnp-2017-317440PubMedGoogle ScholarCrossref
2.
Onder  H , Gocmen  R , Gursoy-Ozdemir  Y .  Reversible transverse sinus collapse in a patient with idiopathic intracranial hypertension.   BMJ Case Rep. 2015:bcr2014011606. doi:10.1136/bcr-2014-011606PubMedGoogle Scholar
3.
Zagardo  MT , Cail  WS , Kelman  SE , Rothman  MI .  Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy?   AJNR Am J Neuroradiol. 1996;17(10):1953-1956.PubMedGoogle Scholar
4.
Hoffmann  J , Kreutz  KM , Csapó-Schmidt  C ,  et al.  The effect of CSF drain on the optic nerve in idiopathic intracranial hypertension.   J Headache Pain. 2019;20(1):59. doi:10.1186/s10194-019-1004-1PubMedGoogle ScholarCrossref
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