Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study

Seizures have been reported in association with idiopathic intracranial hypertension in pediatric patients. Magnetic resonance imaging (MRI) signs of intracranial hypertension have not been investigated before in pediatric patients with new-onset idiopathic seizures. MRI scans of 182 pediatric patients were retrospectively analyzed for imaging findings of intracranial hypertension, including 46 patients with new-onset idiopathic seizures and elevated cerebrospinal fluid opening pressure, 40 patients with new-onset idiopathic seizures and normal opening pressure, 56 patients with confirmed idiopathic intracranial hypertension, and 40 age- and sex-matched controls. The optic nerve sheath diameter is significantly larger in the group with new-onset idiopathic seizures and elevated opening pressure (mean diameter of 6.02 ± 0.45 mm) compared to patients with new-onset idiopathic seizures and normal opening pressure (mean diameter of 5.24 ± 0.50 mm) ( P value <.001). The cutoff value of 6.0 mm for optic nerve sheath diameter showed 63% sensitivity and 88% specificity to differentiate pediatric patients with seizures and elevated opening pressure from those with seizures and normal opening pressure. Conclusion A cutoff value of 6.0 mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.