Skip to main content
Top
Published in: Child's Nervous System 3/2015

01-03-2015 | Original Paper

MR imaging findings in children with pseudotumor cerebri and comparison with healthy controls

Authors: Süreyya Burcu Görkem, Selim Doğanay, Mehmet Canpolat, Gonca Koc, Mehmet S. Dogan, Hüseyin Per, Abdülhakim Coşkun

Published in: Child's Nervous System | Issue 3/2015

Login to get access

Abstract

Objective

The aim of this study was to discuss the MR imaging findings of pseudotumor cerebri in children by comparing with healthy controls.

Materials and methods

Forty-two pseudotumor cerebri patients from hospital records between 2003 and 2011 were retrospectively reviewed. Between 2007 and 2011 25 patients (16 boys, 9 girls) whose brain MR images were on PACS workstation were included. Thirty MR imaging examinations (14 boys, 16 girls) which were interpreted as normal constituted the control group. Two pediatric radiologists reviewed each MRI for optic nerve sheath distension, intraocular protrusion of the optic nerve, posterior globe flattening, horizontal tortuosity of the optic nerve, and decreased pituitary gland size. The sensitivity, specificity, and overall accuracy of the findings on MRI were calculated.

Results

Optic nerve sheath enlarged in the PTC group (mean value, 4.3 mm) than in the control group (mean value, 3.2 mm). It had 88 % sensitivity and 80 % specificity. Pituitary gland size was decreased in PTC group (mean value, 3.63 mm) than in the control group (mean value, 5.05 mm). It had a sensitivity of 64 % and specificity of 90 %. Posterior globe flattening had 56 % sensitivity and 100 % specificity, intraocular protrusion of the optic nerve had 40 % sensitivity and 100 % specificity, and horizontal tortuosity of the optic nerve had 68 % sensitivity and 83 % specificity.

Conclusions

According to our study, posterior globe flattening, intraocular protrusion of the optic nerve, horizontal nerve sheath tortuosity, optic nerve sheath distension, and decreased pituitary gland size are reliable neuroradiological diagnostic markers for pediatric pseudotumor cerebri.
Literature
1.
go back to reference Per H, Canpolat M, Gümüs H, Poyrazoðlu HG, Yikilmaz A, Karaküçük S, Dogan H, Kumandas S (2013) Clinical spectrum of the pseudotumor cerebri in children: etiological, clinical features, treatment and prognosis. Brain Dev 35:561–568CrossRefPubMed Per H, Canpolat M, Gümüs H, Poyrazoðlu HG, Yikilmaz A, Karaküçük S, Dogan H, Kumandas S (2013) Clinical spectrum of the pseudotumor cerebri in children: etiological, clinical features, treatment and prognosis. Brain Dev 35:561–568CrossRefPubMed
2.
go back to reference Gordon K (1997) Pediatric pseudotumor cerebri: descriptive epidemiology. Can J Neurol Sci 24:219–221PubMed Gordon K (1997) Pediatric pseudotumor cerebri: descriptive epidemiology. Can J Neurol Sci 24:219–221PubMed
3.
go back to reference Ko MW, Liu GT (2010) Pediatric idiopathic intracranial hypertension (pseudotumor cerebri). Horm Res Paediatr 74:381–389CrossRefPubMed Ko MW, Liu GT (2010) Pediatric idiopathic intracranial hypertension (pseudotumor cerebri). Horm Res Paediatr 74:381–389CrossRefPubMed
4.
go back to reference Rangwala LM, Liu GT (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52:597–617CrossRefPubMed Rangwala LM, Liu GT (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52:597–617CrossRefPubMed
5.
go back to reference Smith JL (1985) Whence pseudotumor cerebri? J Clin Neuro-Ophthalmol 5:55–56 Smith JL (1985) Whence pseudotumor cerebri? J Clin Neuro-Ophthalmol 5:55–56
6.
go back to reference Friedman DI, Jacobson DM (2004) Idiopathic intracranial hypertension. J Neuroophthalmol 24:138–145CrossRefPubMed Friedman DI, Jacobson DM (2004) Idiopathic intracranial hypertension. J Neuroophthalmol 24:138–145CrossRefPubMed
7.
go back to reference Lim MJ, Pushparajah K, Jan W, Calver D, Lin JP (2010) Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 25:294–299CrossRefPubMed Lim MJ, Pushparajah K, Jan W, Calver D, Lin JP (2010) Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 25:294–299CrossRefPubMed
8.
go back to reference Maralani PJ, Hassanlou M, Torres C, Chakraborty S, Kingstone M, Patel V, Zackon D, Bussière M (2012) Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 67:656–663CrossRefPubMed Maralani PJ, Hassanlou M, Torres C, Chakraborty S, Kingstone M, Patel V, Zackon D, Bussière M (2012) Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 67:656–663CrossRefPubMed
9.
go back to reference Hoffmann J, Huppertz HJ, Schmidt C (2013) Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia 33:1075–1084CrossRefPubMed Hoffmann J, Huppertz HJ, Schmidt C (2013) Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia 33:1075–1084CrossRefPubMed
10.
go back to reference Butros SR, Goncalves LF, Thompson D, Agarwal A, Lee HK (2012) Imaging features of idiopathic intracranial hypertension, including a new finding: widening of the foramen ovale. Acta Radiol 53:682–688CrossRefPubMed Butros SR, Goncalves LF, Thompson D, Agarwal A, Lee HK (2012) Imaging features of idiopathic intracranial hypertension, including a new finding: widening of the foramen ovale. Acta Radiol 53:682–688CrossRefPubMed
11.
go back to reference Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A (2012) Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. AJNR Am J Neuroradiol 33:366–369CrossRefPubMed Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A (2012) Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. AJNR Am J Neuroradiol 33:366–369CrossRefPubMed
12.
go back to reference Degnan AJ, Levy LM (2011) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 32:1986–1993CrossRefPubMed Degnan AJ, Levy LM (2011) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 32:1986–1993CrossRefPubMed
13.
go back to reference Brodsky MC (2004) Flattening of the posterior sclera: hypotony or elevated intracranial pressure? Am J Ophthalmol 138:511CrossRefPubMed Brodsky MC (2004) Flattening of the posterior sclera: hypotony or elevated intracranial pressure? Am J Ophthalmol 138:511CrossRefPubMed
14.
go back to reference Mandelstam S, Moon A (2004) MRI of optic disc edema in childhood idiopathic intracranial hypertension. Pediatr Radiol 34:362CrossRefPubMed Mandelstam S, Moon A (2004) MRI of optic disc edema in childhood idiopathic intracranial hypertension. Pediatr Radiol 34:362CrossRefPubMed
15.
go back to reference Brodsky MC, Vaphiades M (1998) Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology 105:1686–1693CrossRefPubMed Brodsky MC, Vaphiades M (1998) Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology 105:1686–1693CrossRefPubMed
16.
go back to reference Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527CrossRefPubMed Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527CrossRefPubMed
17.
go back to reference Madill SA, Connor SE (2005) Computed tomography demonstrates short axial globe length in cases with idiopathic intracranial hypertension. J Neuroophthalmol 25:180–184CrossRefPubMed Madill SA, Connor SE (2005) Computed tomography demonstrates short axial globe length in cases with idiopathic intracranial hypertension. J Neuroophthalmol 25:180–184CrossRefPubMed
18.
go back to reference Yuh WT, Zhu M, Taoka T, Quets JP, Maley JE, Muhonen MG, Schuster ME, Kardon RH (2000) MR imaging of pituitary morphology in idiopathic intracranial hypertension. J Magn Reson Imaging 12:808–813CrossRefPubMed Yuh WT, Zhu M, Taoka T, Quets JP, Maley JE, Muhonen MG, Schuster ME, Kardon RH (2000) MR imaging of pituitary morphology in idiopathic intracranial hypertension. J Magn Reson Imaging 12:808–813CrossRefPubMed
19.
go back to reference Sallomi D, Taylor H, Hibbert J, Sanders MD, Spalton DJ, Tonge K (1998) The MRI appearance of the optic nerve sheath following fenestration for benign intracranial hypertension. Eur Radiol 8:1193–1196CrossRefPubMed Sallomi D, Taylor H, Hibbert J, Sanders MD, Spalton DJ, Tonge K (1998) The MRI appearance of the optic nerve sheath following fenestration for benign intracranial hypertension. Eur Radiol 8:1193–1196CrossRefPubMed
20.
go back to reference Lai LT, Danesh-Meyer HV, Kaye AH (2014) Visual outcomes and headache following interventions for idiopathic intracranial hypertension. J Clin Neurosci 21:1670–1678CrossRefPubMed Lai LT, Danesh-Meyer HV, Kaye AH (2014) Visual outcomes and headache following interventions for idiopathic intracranial hypertension. J Clin Neurosci 21:1670–1678CrossRefPubMed
21.
go back to reference Connor SE, Siddiqui MA, Stewart VR, O’Flynn EA (2008) The relationship of transverse sinus stenosis to bony groove dimensions provides an insight into the aetiology of idiopathic intracranial hypertension. Neuroradiology 50:999–1004CrossRefPubMed Connor SE, Siddiqui MA, Stewart VR, O’Flynn EA (2008) The relationship of transverse sinus stenosis to bony groove dimensions provides an insight into the aetiology of idiopathic intracranial hypertension. Neuroradiology 50:999–1004CrossRefPubMed
22.
go back to reference Higgins JN, Gillard JH, Owler BK, Harkness K, Pickard JD (2004) MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75:621–625CrossRefPubMedCentralPubMed Higgins JN, Gillard JH, Owler BK, Harkness K, Pickard JD (2004) MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75:621–625CrossRefPubMedCentralPubMed
23.
go back to reference Manfré L, Lagalla R, Mangiameli A, Lupo F, Giuffré G, Ponte F, Cardinale AE (1995) Idiopathic intracranial hypertension: orbital MRI. Neuroradiology 37:459–461CrossRefPubMed Manfré L, Lagalla R, Mangiameli A, Lupo F, Giuffré G, Ponte F, Cardinale AE (1995) Idiopathic intracranial hypertension: orbital MRI. Neuroradiology 37:459–461CrossRefPubMed
24.
go back to reference Rogers DLA (2014) Review of pediatric idiopathic intracranial hypertension. Pediatr Clin North Am 61:579–590CrossRefPubMed Rogers DLA (2014) Review of pediatric idiopathic intracranial hypertension. Pediatr Clin North Am 61:579–590CrossRefPubMed
Metadata
Title
MR imaging findings in children with pseudotumor cerebri and comparison with healthy controls
Authors
Süreyya Burcu Görkem
Selim Doğanay
Mehmet Canpolat
Gonca Koc
Mehmet S. Dogan
Hüseyin Per
Abdülhakim Coşkun
Publication date
01-03-2015
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 3/2015
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-014-2579-0

Other articles of this Issue 3/2015

Child's Nervous System 3/2015 Go to the issue