Comparison of basion opisthion distance and nuchal skin thickness in patients with idiopathic intracranial hypertension with the normal population

Aim: To measure basion opisthion distance and nuchal skin thickness from this level by using sagittal T2A Magnetic Resonance Imaging (MRI) method in Idiopathic Intracranial Hypertension (IIH) patients who meet the Modified Dandy criteria and compare them with the normal population. Material and Method: Our study was selected from patients aged 20-60 years who were diagnosed with IIH according to the modified Dandy criteria (Friedman et al. 2013), who applied to Dicle University Medical Faculty Hospital between 01.06.2013 and 01.04.2020. 40 patients who were included in our study and who had cranial MRI examination and 70 control group without any pathological imaging findings in their cranial MRI were selected. Cases were made retrospectively. Our patient group was determined by searching the keywords "Idiopathic Intracranial Hypertension" and " Pseudotumor Cerebri" in the PACS (Picture Archiving Communications Systems) system, which is the digital archive used in our hospital. The CSF pressure value of the selected patients was obtained by scanning the information operating system (Probel) in the hospital, and those with a CSF opening pressure above 250 mm were included in the study. In the case group, secondary causes of increased intracranial pressure such as intracranial mass, bleeding, hydrocephalus, sinus vein thrombosis (SVT) in cranial MRG were determined and excluded from the study. The control group, on the other hand, was selected from 70 patients without any central nervous system or chronic diseases, whose age (between 20-60 years) and gender distributions were similar to the case group, and no pathology was observed in the cranial MRI, by scanning the digital archive in the PACS system. Exclusion criteria from the study; Being younger than 20 years old and older than 60 years old, not reaching CSF opening pressure value with lumbar puncture (LP), refusing to perform LP, opening CSF pressure to be higher than 250 mmH20, using drugs that can change CSF pressure (such as acetazolamide, topiramate, furosemide, etc.), presence of a disease involving the central nervous system (CNS) (intracranial mass, infection, thrombosis, bleeding, etc.), an intracranial interventional procedure (such as shunt, operation). Results: A total of 110 patients, 40 cases and 70 controls, were included in the study. The mean age of the case group was 35.2±9.0 years, and the control group was 34.8±9.2 years. There was no significant difference in age between the groups (p=0.791). While 36% (90%) of the case group were female and 4 (10%) were male, 62 (88.1%) of the control group were female and 8 (12.9%) were male. There was no significant difference between the groups in terms of gender. When the MRI results of the patients included in the study were examined, 35 (87.5%) had widening of the preoptic CSF distances, 30 (75%) partial empty sella, 17 (75%) optic nerve tortuosity, 7 (17.5%) enlargement in the trigeminal system. 2 (5%) had transverse sinus stenosis and 3 (7.5%) had other findings. The Basion-Opisthion distance of the case group was found to be 36.3±3.1 mm, and the control group as 32.3+2.8 mm, and the value of the case group was found to be significantly higher than the control group (p<0.001). The nuchal thickness of the case group was 9.7±2.6 mm, and the control group was 6.9±1.9 mm, and the value of the case group was found to be significantly higher than the control group (p<0.001). Conclusion: We think that two parameters (nuchal thickness and basion opistion distance) that we think may be radiological imaging findings of İİH may be a marker in the diagnosis of the disease and nuchal translucency may be a parameter that will correlate with clinical improvement in the follow up of weight loss.