Magnetic Resonance Imaging Findings in Children with Papilledema

This retrospective cross-sectional study aimed to determine the prevalence and significance of MRI intracranial hypertension signs in children undergoing imaging for any clinical indication and investigate their correlation with papilledema findings. Data were analyzed from 160 children under 15 years who underwent both head MRI and ophthalmologic examination within a one-month interval at two tertiary medical centers in Israel over a two-year period. Ten established radiological markers associated with intracranial hypertension were evaluated by two specialized neuroradiologists, and ophthalmologic examinations were performed to assess for papilledema. Papilledema was confirmed in 19 patients (11.9%). Six MRI signs showed significant association with papilledema (p < .05), with optic nerve head protrusion demonstrating the highest odds ratio (OR = 30.2; 95% CI, 8.5-107.4; p < .001). Patients with papilledema had a significantly higher mean number of radiological signs than those without (3.1 vs 0.7, p < .001). The presence of at least one positive MRI sign increased papilledema odds (OR = 8.2), while more than three positive signs substantially elevated this risk (OR = 14.9). Both individual radiological markers and their cumulative presence significantly increase the likelihood of papilledema in children. Even when discovered incidentally, multiple MRI signs of intracranial hypertension warrant careful ophthalmological evaluation, as the presence of three or more radiological indicators is associated with nearly 15-fold increased odds of papilledema.