Departments of Otolaryngology-Head and Neck Surgery.
Neurology.
Otol Neurotol. 2023 Jun 1;44(5):525-528. doi: 10.1097/MAO.0000000000003847. Epub 2023 Mar 14.
Many but not all patients with idiopathic intracranial hypertension (IIH) have pulsatile tinnitus (PT). However, little is known about why some patients with IIH develop PT and others do not. The purpose of this study was to determine if any of the classic magnetic resonance imaging (MRI)-detectable markers of IIH differ between patients with and without PT, thereby shedding light on potential pathophysiology.
A retrospective age-matched cohort study of patients with documented IIH (diagnosed by neuro-ophthalmologist) was performed. All patients had MRI performed around the time of diagnosis. MRIs were assessed for 16 variables known to be associated with IIH (e.g., pituitary displacement/empty sella, optic nerve tortuosity, transverse sinus stenosis, inferior cerebellar tonsils, arachnoid granulations, slit-like ventricles) by two blinded neuroradiologists. All binary variables were analyzed via χ2 test with Yates correction, or Fisher exact when appropriate. Continuous variables were analyzed via Student t test. Inter-rater reliability for binary variables was assessed by Cohen κ . For continuous variables, intraclass correlation coefficient was calculated.
Forty age-matched patients with IIH met the inclusion criteria (20 with PT, 20 without PT). For all known binary MRI findings associated with IIH, there were no statistically significant differences between groups. Likewise, there were no statistically significant differences for continuous variables.
The classic MRI findings associated with IIH do not differ between patients with and without PT, suggesting that systemic (rather than localized intrinsic or extrinsic) factors may play a critical role in the pathophysiology.
许多，但不是所有特发性颅内高压（IIH）患者都有搏动性耳鸣（PT）。然而，对于为什么一些 IIH 患者会出现 PT，而另一些患者则不会，人们知之甚少。本研究的目的是确定 IIH 的任何经典磁共振成像（MRI）可检测标志物是否在有和无 PT 的患者之间存在差异，从而为潜在的病理生理学提供线索。
对有明确 IIH 病史的患者（由神经眼科医生诊断）进行了回顾性年龄匹配队列研究。所有患者在诊断时均进行 MRI 检查。MRI 由两名盲法神经放射科医生评估与 IIH 相关的 16 个变量（例如，垂体移位/空蝶鞍、视神经迂曲、横窦狭窄、小脑下蚓部、蛛网膜颗粒、裂隙样脑室）。所有二项变量均通过 χ2 检验（Yates 校正）或 Fisher 确切检验（适当）进行分析。连续变量通过 Student t 检验进行分析。二项变量的组内一致性通过 Cohen κ 进行评估。对于连续变量，计算了组内相关系数。
符合纳入标准的 40 名年龄匹配的 IIH 患者（20 名有 PT，20 名无 PT）。对于所有与 IIH 相关的已知 MRI 二项发现，两组之间没有统计学上的显著差异。同样，连续变量也没有统计学上的显著差异。
与 IIH 相关的经典 MRI 发现在有和无 PT 的患者之间没有差异，这表明系统性（而不是局部内在或外在）因素可能在病理生理学中发挥关键作用。
