Computed tomographic evaluation of increased intracranial pressure without localizing signs

Area of Science:

• Neurology
• Radiology
• Neuro-ophthalmology

Background:

• Papilledema, often indicating increased intracranial pressure, requires accurate diagnosis.
• Distinguishing structural lesions from benign intracranial hypertension is crucial for patient management.
• Computed tomography (CT) is a primary neuroimaging modality.

Purpose of the Study:

• To evaluate the utility of CT in diagnosing neurological conditions in alert patients presenting with papilledema and no focal neurological deficits.
• To determine if CT can differentiate between structural intracranial lesions and pseudotumor cerebri (idiopathic intracranial hypertension).

Main Methods:

• Retrospective analysis of 29 alert patients with papilledema and no localizing neurological signs.
• Evaluation of CT scans for ventricular enlargement and abnormal tissue density.
• Comparison of CT findings with subsequent diagnostic procedures when performed.

Main Results:

• CT demonstrated lesions in 8 patients, characterized by ventricular enlargement or abnormal tissue density.
• 19 patients showed normal ventricles on CT, suggesting pseudotumor cerebri.
• Only 6 patients with normal CT findings underwent further investigation with pneumoencephalography.

Conclusions:

• CT is valuable in evaluating alert patients with papilledema and no localizing signs.
• CT can identify ventricular abnormalities and abnormal tissue densities suggestive of intracranial pathology.
• CT assists in the diagnosis of benign intracranial hypertension, potentially obviating the need for pneumoencephalography or angiography.