Abstract Background: Idiopathic intracranial hypertension (IIH) is an idiopathic condition. MRI is essential to exclude elevated cerebrospinal fluid pressure due to other causes such as brain tumour, dural sinus thrombosis, hydrocephalus, etc. Aims: to determine the role of brain magnetic resonance imaging and venography in the diagnosis of idiopathic intracranial hypertension and to determine the sensitivity and specificity of each single radiological sign and in combination. Patients and method: A prospective case control study was done in Al- Imamain Al-Kadhmain medical city between September 2021 and November 2022. A random selection of 40 patients (3 males and 37 females) with clinical features, neurological examination, brain MRI/ MRV and confirmed diagnosis of IIH. Forty controls were also randomly selected. A total of 10 brains MRI/MRV signs were evaluated. Results: There is significant difference of the 10 MRI signs between patient group and control group. Regarding the sensitivity and specificity of each MRI sign: empty sella (97% sensitive, 77% specific), flat sclera (82%, 95%), Perioptic nerve sheath distension (90%, 95%), Intraocular protrusion (22%, 100%), vertical tortouisity f the optic nerve (35%, 95%), enlarged meckel’s cave (82%, 92%), posterior displacement of the stalk (67%, 75%), slit like ventricle (55%, 97%), meningoceles (15%, 97%) and cerebral venous sinus stenosis (70%, 92%). Combination of MRI signs increases the sensitivity and specificity with combination of 3 signs and above would reach 100% specificity. Conclusion: Five MRI signs have the highest sensitivity and specificity (flat sclera, perioptic nerve sheath distension, empty sella, large meckel’s cave, and cerebral venous sinus stenosis). Combination of MRI signs especially (optic nerve tortuosity/ optic nerve distension) and (flat sclera/ optic nerve distension) has significantly increased the sensitivity and specificity. Presence of 3 signs or more has the highest specificity.
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