Neuroimaging markers of intracranial hypertension in cerebral venous thrombosis: A systematic review and meta-analysis.

Background: Cerebral venous thrombosis (CVT) is commonly associated with intracranial hypertension (IH), though its neuroimaging markers remain less well-defined. This study aims to systematically review and compare neuroimaging markers of IH in CVT and idiopathic IH (IIH) to better understand their diagnostic implications.

Methods: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. From inception to 2024, we searched PubMed, Web of Science, and Scopus for observational studies and randomized controlled trials focusing on neuroimaging findings in primary IH (i.e., IIH) and IH secondary to CVT. Data were extracted on neuroimaging outcomes, including peri-optic cerebrospinal fluid (CSF) pressure, optic nerve head protrusion, and others.

Results: Six studies met the eligibility criteria, comprising three cohort studies and three case-control studies, with a combined total of 301 patients. The results indicated that peri-optic CSF pressure (Odds ratio [OR]: 5.85, P = 0.0002), optic nerve head protrusion (OR: 4.1, P = 0.02), sclera flattening (OR: 2.2, P = 0.04), and empty sella (OR: 3.25, P = 0.03) were observed more frequently in patients with IIH than in those with CVT and IH. However, when comparing CVT with IH to controls, optic nerve tortuosity did not show a significant difference (OR: 2.20, P = 0.18). Increased ventricular volume (Mean difference: 1.76, P < 0.00001) and sclera flattening (OR: 6.68, P = 0.002) were more common in CVT with IH patients compared to the control group.

Conclusion: Typical neuroimaging characteristics of IH (e.g., empty sella) are more frequently observed in idiopathic cases (i.e., IIH) than in secondary causes, such as IH resulting from CVT. These differences have the potential to enhance diagnostic precision and facilitate the development of improved imaging protocols.