1*Postgraduate, Department of Ophthalmology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
2Professor and Head, Department of Ophthalmology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
3Professor, Department of Ophthalmology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
*Corresponding Author: Dr. Snegapriya Thangaraj, Postgraduate, Department of Ophthalmology, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
Background: Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure without an identifiable structural cause. The condition predominantly affects women of reproductive age and often presents with visual disturbances and papilloedema. This case series highlights the role of multimodal imaging in the diagnosis and management of IIH and explores its clinical variability across different patient profiles.
Methods: Five patients diagnosed with IIH were evaluated at a tertiary care center. Detailed ophthalmic examination, B-scan ultrasonography, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were performed for all cases. Parameters assessed included optic nerve sheath diameter (ONSD), papilloedema grade, and neuroimaging findings such as empty sella and transverse sinus narrowing. Clinical response to medical therapy and follow-up outcomes were documented.
Results: The mean age of presentation was 41.8 years, with a female-to-male ratio of 4:1. All patients exhibited bilateral papilloedema, and ONSD measurements ranged between 5.27 mm and 5.75 mm. MRI revealed partial or complete empty sella in four cases, while MRV demonstrated transverse sinus narrowing or hypoplasia in all five. One male patient presented with abducens nerve palsy, and one postpartum female had grade 4 papilloedema. All patients responded favorably to acetazolamide 250 mg twice daily, with stabilization of visual acuity and reduction in optic disc edema during follow-up. No surgical intervention was required.
Conclusion: This series underscores the diagnostic precision of multimodal imaging in IIH. The combination of B-scan ultrasonography, MRI, and MRV effectively identifies raised intracranial pressure and venous outflow abnormalities. The findings reaffirm the predominance of IIH in females, the association with postpartum and hormonal states, and the potential for atypical presentations such as cranial nerve palsy. Early diagnosis, structured follow-up, and medical therapy remain crucial in preventing irreversible optic atrophy and ensuring favorable long-term outcomes.
Keywords: Idiopathic intracranial hypertension, papilloedema, optic nerve sheath diameter, empty sella, venous sinus stenosis, multimodal imaging, acetazolamide.
How to cite this article: Thangaraj S, Chandrasekaran B, Chellakumar V. Multimodal Imaging in the Diagnosis of Idiopathic Intracranial Hypertension: Lessons from Clinical Case Series. Int J Drug Deliv Technol. 2026;16(12s): 839-850. DOI: 10.25258/ijddt.16.12s.100
Source of support: Nil.
Conflict of interest: None