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Open Access 27-04-2024 | Intracranial Hypertension | Diagnostic Neuroradiology

Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis

Authors: Florian F. Schuchardt, Niklas Lützen, Sebastian Küchlin, Michael Reich, Wolf A. Lagrèze, Hansjörg Mast, Matthias Weigel, Stephan Meckel, Horst Urbach, Cornelius Weiller, Andreas Harloff, Theo Demerath

Published in: Neuroradiology

Abstract

Purpose

Intracranial hypertension (IH) frequently complicates cerebral venous thrombosis (CVT). Distinct neuroimaging findings are associated with IH, yet their discriminative power, reversibility and factors favoring normalization in prospective CVT patients are unknown. We determined test performance measures of neuroimaging signs in acute CVT patients, their longitudinal change under anticoagulation, association with IH at baseline and with recanalization at follow-up.

Methods

We included 26 consecutive acute CVT patients and 26 healthy controls. Patients were classified as having IH based on CSF pressure > 25 cmH₂O and/or papilledema on ophthalmological examination or ocular MRI. We assessed optic nerve sheath diameter (ONSD), optic nerve tortuousity, bulbar flattening, lateral and IV^th ventricle size, pituitary configuration at baseline and follow-up, and their association with IH and venous recanalization.

Results

46% of CVT patients had IH. ONSD enlargement > 5.8 mm, optic nerve tortuousity and pituitary grade ≥ III had highest sensitivity, ocular bulb flattening and pituitary grade ≥ III highest specificity for IH. Only ONSD reliably discriminated IH at baseline. Recanalization was significantly associated with regressive ONSD and pituitary grade. Other neuroimaging signs tended to regress with recanalization. After treatment, 184.9 ± 44.7 days after diagnosis, bulbar flattening resolved, whereas compared with controls ONSD enlargement (p < 0.001) and partially empty sella (p = 0.017), among other indicators, persisted.

Conclusion

ONSD and pituitary grading have a high diagnostic value in diagnosing and monitoring CVT-associated IH. Given their limited sensitivity during early CVT and potentially persistent alterations following IH, neuroimaging indicators can neither replace CSF pressure measurement in diagnosing IH, nor determine the duration of anticoagulation.

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Title: Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis
Authors: Florian F. Schuchardt
Niklas Lützen
Sebastian Küchlin
Michael Reich
Wolf A. Lagrèze
Hansjörg Mast
Matthias Weigel
Stephan Meckel
Horst Urbach
Cornelius Weiller
Andreas Harloff
Theo Demerath
Publication date: 27-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Intracranial Hypertension
Venous Thrombosis
Venous Thrombosis
Phenprocoumon
CSF Pressure Measurement
Published in: Neuroradiology
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-024-03363-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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