Digital subtraction angiography as an additional modality in idiopathic intracranial hypertension and its comparison with magnetic resonance venography: A prospective study

Kishor Kumar Paikara; Chandradev Sahu; Arpit Agrawal; Abhijeet Kumar Kohat; Anam Fatima

doi:10.55697/tnd.2025.240

Kishor Kumar Paikara¹, Chandradev Sahu¹, Arpit Agrawal², Abhijeet Kumar Kohat², Anam Fatima¹

¹Department of Radiology, Pandit Jawaharlal Nehru Memorial Medical College, Raipur, India
²Department of Neurology, Dau Kalyan Singh Post Graduate Institute and Research Centre (DKSPGI & RC) Raipur, India

Keywords: Digital subtraction angiography, idiopathic intracranial hypertension, magnetic resonance venography, venous sinus stenting, transverse sinus stenosis.

Abstract

Objectives: This study aimed to compare the diagnostic accuracy of brain magnetic resonance venography (MRV) with digital subtraction angiography (DSA) in the evaluation of idiopathic intracranial hypertension (IIH).

Patients and methods: This cross-sectional, hospital-based, prospective observational study included 15 patients (8 males, 7 females; mean age: 34.3±13.6 years; range, 18 to 60 years) with suspected IIH who met modified Dandy’s criteria for a period of two years (January 2021 to January 2023). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the MRV and DSA to diagnose IIH.

Results: The female participants had a mean age of 30±10.23 years, and the male participants had a mean age of 37±13.46 years. Out of seven female participants, three (42.8%) were obese, two (28.6%) were overweight, and two (28.6%) had normal body mass index (BMI). Of eight male participants, tree (37.5%) were obese, three (37.5%) were overweight, and two (25%) had normal BMI. All patients had headache, 60% had diminished vision, 20% had tinnitus, 20% had diplopia, 46.67% had dizziness, and 80% had papilledema. All the patients underwent lumbar puncture, and cerebrospinal fluid opening pressure was more than 25 cm of water in all patients. Digital subtraction angiography revealed that, two (13.3%) patients had cerebral venous sinus thrombosis, and two (13.3%) patients had dural arteriovenous fistula. The diagnostic accuracy measures of MRV in the diagnosis of IIH showed a sensitivity of 45%, a specificity of 75%, a PPV of 83%, and a NPV of 33%.

Conclusion: In patients with suspected IIH, DSA can rule out cerebrovascular alterations, venous sinus pressure can be measured, and venous sinus stenting can be done in the same sitting, which can be an excellent additional modality for selected patients.

Cite this article as: Paikara KK, Sahu C, Agrawal A, Kohat AK, Fatima A. Digital subtraction angiography as an additional modality in idiopathic intracranial hypertension and its comparison with magnetic resonance venography: A prospective study. Turk J Neurol 2025;31(4):429-434. doi: 10.55697/tnd.2025.240.