Perumbally Hafees Abdullah, Rupa V, Kurien Regi, Jasper Anitha, Nair Shalini, Abraham Lekha, Varghese Lalee, Cherian Lisa Mary, Inja Ranjeetha Rachel, Moorthy Ranjith, Nair Bijesh, Rajshekhar Vedantam
Department of ENT, Christian Medical College, Vellore, India.
Department of Radiology, Christian Medical College, Vellore, India.
Eur Arch Otorhinolaryngol. 2025 Sep 18. doi: 10.1007/s00405-025-09673-6.
To prospectively identify the prevalence of idiopathic intracranial hypertension (IIH) in a cohort of patients with spontaneous cerebrospinal fluid rhinorrhoea (SCSFR) using the previously published clinico-radiological Vellore criteria for IIH.
Patients diagnosed with SCSFR over a 23-month period were prospectively evaluated using clinical methods and neuroimaging. Clinical evaluation included ophthalmological examination by fundoscopy and optical coherence tomography. Optic nerve sheath diameter (ONSD) measurement was performed using ultrasound scanning. Neuroimaging was performed by the acquisition of heavily T2 weighted MR images of the brain and skull base. Patients were categorised into definite, probable and no IIH using the Vellore diagnostic criteria.
Fifty-five patients (45 (81.8%) being women) with a mean age of 43.4+/-9.3 years were recruited to the study. Besides CSF rhinorrhoea, headache was the commonest symptom (70.9%). Eleven (20%) patients had papilledema. Empty sella (Yuh et al. grade IV and V) (74.5%) was the commonest MR finding suggestive of IIH. The overall prevalence of IIH in patients with SCSFR was 85.8%. Of these, 35 (63.7%) had definite IIH, 12 (21.8%) had probable IIH and 8 (14.6%) had no IIH. Older patients were more likely to have definite IIH (mean age, 45.5 ± 9 years) than probable IIH (mean age, 39 ± 8.5 years) with an odds ratio of 1.095 (95% CI, 1.001-1.199)(p = 0.048). Among patients with definite IIH, Meckel's cave enlargement (49.1%) was more frequently seen than posterior globe flattening (21.8%).
Patients with SCSFR have a high likelihood of having IIH. We recommend the use of Vellore criteria, which is highly reliant on MR findings, to avoid under-diagnosis of IIH in these patients.
采用先前发表的用于特发性颅内高压（IIH）的临床放射学韦洛尔标准，前瞻性地确定一组自发性脑脊液鼻漏（SCSFR）患者中IIH的患病率。
对在23个月期间诊断为SCSFR的患者采用临床方法和神经影像学进行前瞻性评估。临床评估包括眼底镜检查和光学相干断层扫描的眼科检查。使用超声扫描测量视神经鞘直径（ONSD）。通过采集大脑和颅底的重T2加权磁共振图像进行神经影像学检查。根据韦洛尔诊断标准将患者分为确诊、可能和无IIH三类。
55例患者（45例（81.8%）为女性）被纳入研究，平均年龄为43.4±9.3岁。除脑脊液鼻漏外，头痛是最常见的症状（70.9%）。11例（20%）患者有视乳头水肿。空蝶鞍（Yuh等IV级和V级）（74.5%）是提示IIH的最常见磁共振表现。SCSFR患者中IIH的总体患病率为85.8%。其中，35例（63.7%）确诊为IIH，12例（21.8%）可能为IIH，8例（14.6%）无IIH。老年患者确诊为IIH（平均年龄，45.5±9岁）的可能性高于可能为IIH（平均年龄，39±8.5岁），优势比为1.095（95%CI，1.001 - 1.199）（p = 0.048）。在确诊为IIH的患者中，Meckel腔扩大（49.1%）比眼球后部扁平（21.8%）更常见。
SCSFR患者患IIH的可能性很高。我们建议使用高度依赖磁共振表现的韦洛尔标准，以避免这些患者中IIH的漏诊。
