Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: A possible presentation of idiopathic intracranial hypertension

Background: Traditionally, idiopathic cerebrospinal fluid (CSF) leaks have been associated with normal intracranial pressure (ICP). We speculate that at least one subset of these leaks may be associated with elevated ICP, more specifically, idiopathic intracranial hypertension (IIH). We sought to identify radiographic manifestations suggestive of elevated ICP in 14 patients with idiopathic CSF leaks who clinically and epidemiologically resembled patients with IIH. Methods: We retrospectively reviewed high-resolution CT, MRI, and/or CT cisternography in 14 patients with elevated ICP and idiopathic CSF leaks for radiographic manifestations suggesting increased ICP. Results: Arachnoid pits were seen in 79% of patients, empty sella was seen in 50% of patients, meningo(encephalo)celes were seen in 50% of patients, and dural ectasia was seen in 35% of patients, respectively. Optic nerve findings were not shown as commonly seen as described in the literature. Conclusion: We show a subset of patients with idiopathic CSF leaks who display radiographic signs consistent with increased ICP who may represent an alternative presentation of IIH.