MR of optic papilla protrusion in patients with high intracranial pressure

To evaluate the signal characteristics of the optic papilla (optic nerve head) on routine cranial MR images in patients with clinical evidence of optic papilla elevation caused by high intracranial pressure, and to compare these findings with findings in healthy adult volunteers.

We reviewed retropectively the MR imaging examinations of 15 patients who were referred with objectively decreased visual acuity and funduscopic findings of optic papilla elevation. T1-weighted and T2-weighted axial MR images were obtained by using conventional spinecho acquisitions on 1.5-T MR imagers. In addition, the MR imaging studies in 10 healthy adult volunteers without visual impairment were reviewed as controls.

In 10 (67%) of the 15 patients, visual elevation of the optic papilla was shown by MR imaging. In all 15 patients, the MR signal intensity of the optic papilla was hypointense relative to the vitreous of the globe on T2-weighted images. In the healthy volunteer group, the optic papillae were all similarly hypointense relative to the vitreous of the globe on T2-weighted images; however, these optic papillae were flat.

Clinical examination and MR imaging may show elevation of the optic papilla in patients with high intracranial pressure. When chronic, optic papilla elevation has been shown to correlate well with severe loss of vision. Actual edema of the optic papilla seems to play little role in the physical elevation observed clinically in the chronic stages of this pathologic process.