Vol. 77, December 2009

Clinical Significance of Improved Distal Optic Nerve & Empty Sella Signs in Patients with Idiopathic Intracranial Hypertension

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Clinical Significance of Improved Distal Optic Nerve & Empty Sella Signs in Patients with Idiopathic Intracranial Hypertension,MAHMOUD M. GAMAL and MOSTAFA Z. ALI

 

Abstract
The Purpose of this study was to evaluate MRI signs of distal ON and empty sella in patients with idiopathic intraranial hypertension, and whether normalization of ICP on long-term follow-up of patients, can be correlated to improvement of these signs. We also thought to correlate these findings with the eventual visual status.
Methods: This study was done at outpatient clinics of Ophthalmology and Neurosurgery departments of Cairo Uni-versity hospital during the period between January 2005 and January 2008. Initially 30 cases were randomly collected. Finally, 6 patients with IIH were included in our prospective study.
Results: Bilateral papilloedema was found in all cases, and was the main diagnostic sign. Ventricular size was within normal in 2 cases (33.3%), and was smaller than normal in 4 cases (66.6%). Flattening of the posterior sclera and distension of the perioptic subarachnoid space were the most frequent signs occurring in 66.6% and 50% of the patients respectively. Empty sella was the least frequent sign and occurred in 16.6% of the patients. All the six cases were followed up by repeated MRI (4 medical and 2 surgical), five of these 6 cases (4 medical, 1 surgical) did show normalization of one or more of the appearance of the pituitary gland and distal ONs on MR images.
Conclusion: The present report concluded that MRI signs and findings of distal ON are very useful tests for IIH, since they are objective, noninvasive and reproducible, they can be performed on uncooperative patients and allow supporting diagnoses in face of unspecified symptoms.

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