039 Prevalence of MRI signs of intracranial hypertension and their association with papilledema: a prospective study using ocular fundus photography

Objectives MRI signs of intracranial hypertension (MRI-IH) are classically associated with idiopathic intracranial hypertension (IIH), but also detected in asymptomatic individuals without papilledema. The objective of this study was to determine the prevalence of MRI-IH in consecutive outpatients undergoing brain MRI for any clinical indication, and explore their association with papilledema. Methods Prospective cross-sectional observational study of outpatients undergoing brain MRI, with ocular fundus photographs taken concurrently. Radiologic studies were analyzed for MRI-IH. Univariate analysis with Fisher’s exact test or t-test was performed. Results Of 296 patients included, the most common indication for MRI was surveillance of a brain neoplasm (27.7%). Investigation of headaches (8.8%) or disorders of raised ICP (1.4%) were uncommon. At least one MRI-IH was present in 49% of patients [empty sella (33.1%), enlarged Meckel’s cave (15.9%), increased peri-optic CSF (10.8%), optic nerve tortuosity (7.8%), scleral flattening (0.7%), cephaloceles (1.4%)]. Bilateral transverse venous sinus stenosis (TVSS) was present in 3.0% of 198 patients. Five patients (1.7%) had papilledema. Compared to patients without papilledema, those with papilledema had significantly higher BMI and prior history of IIH, and increased prevalence of empty sella, optic nerve tortuosity, and TVSS on MRI. The prevalence of papilledema increased from 2.8% among patients with at least one MRI-IH to 40% among patients with four or more MRI-IH. Conclusion MRI-IH are common in patients undergoing brain MRI, but rarely associated with papilledema. The management of patients with incidentally detected MRI-IH likely does not require systematic lumbar puncture unless concerning symptoms or papilledema are present.