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

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

doi:10.1007/s00234-024-03363-6

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

Neuroradiology. 2024 Apr 27. doi: 10.1007/s00234-024-03363-6. Online ahead of print.

Authors

Affiliations

¹ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. florian.schuchardt@googlemail.com.
² Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Allschwil, Switzerland.
⁵ Department of Neurology, University Hospital Basel, Basel, Switzerland.
⁶ Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
⁷ Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.
⁸ Institute of Diagnostic and Interventional Neuroradiology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany.
⁹ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 38676750
DOI: 10.1007/s00234-024-03363-6

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.

Keywords: Cerebral venous thrombosis; Intracranial hypertension; Neuroimaging indicators; Optic nerve sheath diameter; Partially empty sella.