To evaluate the relationship between the severity of pediatric IIH (as defined by initial symptom burden and/or opening pressure) with MRI/MRV findings.

Given the potential for irreversible vision loss, tools for early recognition and diagnosis of IIH are essential. Imaging findings may prove especially useful in the pediatric population given the wide range of presentations and potentially differing diagnostic cutoffs that may limit clinical suspicion. Studies regarding the applicability of common adult imaging findings to the pediatric population are limited. Therefore, there is a need to better characterize MRI/MRV findings in the pediatric population, along with their relationship to disease severity.

Retrospective cohort study with existing EMR data from an outpatient neuro-ophthalmology clinic. Demographic, symptomatologic, and diagnostic data from fifty patients between the ages of 5 and 18 years old were utilized.

Patients with bilateral dural venous sinus stenosis called on brain MRV around the time of diagnosis had a higher diagnostic opening pressure (p=0.04) and less blurry vision reported at time of diagnosis (p=0.019). Reduced pituitary gland height (empty sella), tonsillar descent (without chiari), increased optic nerve sheath diameter, flattening of the posterior globe, and unilateral dural venous sinus stenosis were not significantly associated with symptom burden or opening pressure. 

Our results suggest an association between the severity of IIH in terms of diagnostic opening pressure at time of diagnosis and bilateral venous sinus stenosis on brain MRV. Given potentially lower opening pressures in the prepubertal pediatric population, imaging findings such as these may help clinicians support diagnoses in the correct clinical context. Given the wide variation of clinical presentation in the pediatric population and the absence of pediatric-specific diagnostic criteria, clinicians may consider closer surveillance for such findings when evaluating diagnostic imaging.