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This study investigates whether MRI features of IIH differ in atypical demographic subgroups and their association with visual outcomes.

February 9, 2026European Radiology3 citationsOpen Access

MRI features in atypical idiopathic intracranial hypertension

TKTheresia KnocheBerlin Institute of Health at Charité - Universitätsmedizin Berlin NGNehir GuelsoyCharité - Universitätsmedizin Berlin JRJoachim RötherVascular Medicine

Key Points

This study investigates whether MRI features of IIH differ in atypical demographic subgroups and their association with visual outcomes.
Retrospective cohort study design
Investigated MRI features in males, individuals with normal BMI, and patients aged over 45
Evaluated presence of specific MRI features such as empty sella and optic nerve sheath distension
Examined correlation between MRI features and visual prognosis
172 patients were included in the study
Empty sella was the most common feature at 87%
Other features included optic nerve sheath distension at 60% and transverse sinus stenosis at 46%
No significant differences in MRI features were found between typical and atypical groups
Regression models showed no associations between MRI features and visual outcomes

Abstract

Abstract Objectives Idiopathic intracranial hypertension (IIH) primarily affects obese women of reproductive age. However, IIH can also occur in individuals outside this typical demographic, where it is associated with a more severe clinical course and poorer visual outcome. Characteristic features of IIH have been identified on cerebral MRI but have not been systematically studied in atypical patient subgroups. Materials and methods This retrospective cohort study investigated the prevalence of MRI features of IIH across the following subgroups: males, individuals with normal BMI (< 26 kg/m 2 ), and patients diagnosed above the age of 45. The presence of empty sella (ES), posterior globe flattening (PGF), optic nerve sheath distension (ONSD), optic nerve tortuosity (ONT), transverse sinus stenosis (TSS), DWI-hyperintensity of the optic nerve head (ONH) and ONH-contrast enhancement were evaluated on MRI. The relationship between MRI features and the visual prognosis was investigated. Results The study included 172 patients. ES was most frequent with 87%, followed by ONSD in 60%, TSS in 46%, ONT in 39% and PGF in 37%. ONH-DWI hyperintensity was present in 35%, and ONH-contrast enhancement in 22%. The prevalence of MRI features did not significantly differ across demographic subgroups and between atypical and typical IIH. Regression models did not indicate associations between MRI features and visual outcomes. Conclusions MRI features of IIH were equally prevalent in typical and atypical demographics. These findings suggest a consistent radiological presentation of IIH across demographic profiles, indicating a shared imaging phenotype regardless of atypical clinical characteristics. Limitations related to the retrospective design warrant future prospective studies. Key Points Question Do MRI features of IIH differ across demographic subgroups (males, non-obese and older patients) and are they associated with visual outcomes? Findings MRI features of IIH were equally prevalent in typical and atypical patients; however, no significant association between imaging findings and visual outcome was observed . Clinical relevance While MRI supports the diagnosis of IIH across demographic subgroups, established imaging features do not seem to aid in identifying patients at risk of visual deterioration . Graphical Abstract

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