Venous manometry could aid idiopathic intracranial hypertension diagnosis

AUSTIN, Texas — Venous manometry and neuroimaging may provide additional value when diagnosing patients who do not meet criteria for idiopathic intracranial hypertension, according to a poster presented here.

“When it comes to IIH, we have patients who would simply respond to medical treatment, but then we have a very large group of patients who don’t respond and are sort of a mystery because either they would not have the typical signs and symptoms ... or they wouldn’t have the imaging findings that we normally require to make these diagnoses in these patients,” Areeba Nisar, MD, a research assistant at Jefferson Headache Center, told Healio.

According to researchers, Friedman criteria for diagnosing idiopathic intracranial hypertension (IIH) includes a lumbar puncture opening pressure of 25 cmHO or greater and at least three neuroimaging features.

To understand the relationship between these criteria and venous manometry, Nisar and colleagues identified 20 patients who were evaluated for refractory IIH and underwent venous manometry. Researchers analyzed neuroimaging for signs of IIH and compared pressure changes due to venous sinus stenosis.

“What we have seen is that almost all the patients who had a severe gradient of stenosis were diagnosed as typical IIH patients,” Nisar said.

However, researchers noted that patients with transverse sinus stenosis may not always have typical IIH symptoms of headache, pulsatile tinnitus, papilledema and opening pressure of at least 25 cmHO, which limits the diagnostic sensitivity via current IIH criteria.

Neuroimaging and venous manometry measurement can help clinicians identify, diagnose and treat these patients, Nisar said.

“If you have a patient that you suspect has IIH and you think that the patient is in dire need of treatment and diagnosis, you can refer them to venous manometry,” she said.