Magnetic Resonance Imaging Findings in Idiopathic Intracranial Hypertension With and Without Pulsatile Tinnitus: An Age-Matched Cohort Study

Abstract

ObjectiveMany but not all patients with idiopathic intracranial hypertension (IIH) have pulsatile tinnitus (PT). However, little is known about why some patients with IIH develop PT and others do not. The purpose of this study was to determine if any of the classic magnetic resonance imaging (MRI)–detectable markers of IIH differ between patients with and without PT, thereby shedding light on potential pathophysiology.MethodsA retrospective age-matched cohort study of patients with documented IIH (diagnosed by neuro-ophthalmologist) was performed. All patients had MRI performed around the time of diagnosis. MRIs were assessed for 16 variables known to be associated with IIH (e.g., pituitary displacement/empty sella, optic nerve tortuosity, transverse sinus stenosis, inferior cerebellar tonsils, arachnoid granulations, slit-like ventricles) by two blinded neuroradiologists. All binary variables were analyzed via χ2 test with Yates correction, or Fisher exact when appropriate. Continuous variables were analyzed via Student t test. Inter-rater reliability for binary variables was assessed by Cohen κ. For continuous variables, intraclass correlation coefficient was calculated.ResultsForty age-matched patients with IIH met the inclusion criteria (20 with PT, 20 without PT). For all known binary MRI findings associated with IIH, there were no statistically significant differences between groups. Likewise, there were no statistically significant differences for continuous variables.ConclusionsThe classic MRI findings associated with IIH do not differ between patients with and without PT, suggesting that systemic (rather than localized intrinsic or extrinsic) factors may play a critical role in the pathophysiology.

Clinical Predictors of Pulsatile Tinnitus in Patients With Idiopathic Intracranial Hypertension: An Age-Matched Cohort Study

“…In fact, none of the traditional neuro-and neuro-ophthalmological measurements differed significantly between the two groups. Likewise, our group has previously demonstrated that radiologic abnormalities associated with IIH also do not correlate with the presence of PT (14). Therefore, if not disease severity, what is going on?…”

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring

“…Furthermore, 42% of our participants exhibited dehiscence without ipsilateral arachnoid granulation in TS. These findings suggest that TS invagination of arachnoid granulation may not be the ultimate cause of PT (37), but rather a sign indicating regional hemodynamic-cerebrospinal fluid dysregulation at the anastomosis of Labbe or larger veins running into TS (39).…”

“…Despite the strong correlation between PT and idiopathic intracranial hypertension (IIH) postulated by other studies (35)(36)(37)(38), most Asian patients do not meet the diagnostic criteria for definitive IIH and rarely exhibit associated symptoms. These symptoms are more likely related to body mass index (35).…”