Radiographic Findings Link Idiopathic Intracranial Hypertension With Spontaneous Cerebrospinal Fluid Leaks

Technician preparing scanner for patient
Research explores the high rate of IIH-associated features in those with cerebrospinal fluid leaks.

The following article is a part of conference coverage from the 2021 meeting of the North American Neuro-Ophthalmology Society, being held virtually from February 20 to 23, 2021. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by these leading experts in neuro-ophthalmology. Check back for more from the NANOS 2021 Meeting.


Idiopathic intracranial hypertension (IIH) may be a contributing factor in spontaneous cerebrospinal fluid (CSF) leaks, according to research presented at the North American Neuro-Ophthalmology (NANOS) 2021 Annual Meeting, held virtually February 20 through 23, 2021. 

Currently, the radiological overlap between IIH and CSF leaks is poorly characterized. Previous pooled study data suggests that empty sella can be observed in 60% of people with spontaneous cerebrospinal fluid leaks; optic nerve tortuosity, dilated optic nerve sheaths, and flattened posterior globes are far less common.2 However, because previous studies have not reported on radiologic findings in people with spontaneous CSF leaks, researchers reported on the imaging findings in this patient population. 

A blinded neuro-radiologist reviewed computed tomography and magnetic resonance images taken prior to CSF leak repair for features including empty sella, flattened posterior globes, dilated optic nerve sheaths, tortuous optic nerves, transverse venous sinus stenosis, tonsillar descent, enlarged Meckel’s cave, and enlarged foramina rotunda. Patient charts were also reviewed both pre- and post-repair for symptoms of IIH symptoms, eye exams, and data on lumbar puncture. 

The total patient cohort included 12 patients (mean age, 53.1 years; range, 33 years to 66 years; 91.7% women). Seven patients demonstrated symptoms of IIH prior to CSF leak repair and 11 demonstrated radiologic features IIH on examination. 

The most common radiologic feature was a dilated optic nerve sheath, identified in 91.7% of patients; 75% of patients exhibited empty sella and another 75% exhibited enlarged Meckel’s cave. Approximately  66% exhibited a flattened posterior globe, 58.3% exhibited tonsillar descent, 50% demonstrated a tortuous optic nerve, 41.7% exhibited an enlarged foramina rotunda, and 16.7% exhibited transverse venous sinus stenosis. 

“Radiologic findings of IIH are common in patients with spontaneous CSF leaks,” the researchers note, adding that the reported prevalence of the findings in this study has limitations, including the small sample size and the potential for referral or confirmation bias. 

Idiopathic intracranial hypertension should be considered as a possible contributing factor for spontaneous CSF leaks,” the report concludes. 

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  1. Chodnicki K, Maher M, Gray S, Chwalisz B. Frequency of radiologic features of intracranial hypertension in patients with spontaneous cerebrospinal fluid leaks. Presented at: North American Neuro-Ophthalmology Society (NANOS) 2021 Annual Meeting; February 20-23, 2021; Poster 104.
  2. Bidot S, Levy JM, Saindane AM, Oyesiku NM, Newman NJ, Biousse V. Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension? J Neuroophthalmol. 2019;39(4):487-495.