Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema: Comment

Letters to the Editor 4. De Bernardo M, Vitiello L, Rosa N. Ocular ultrasound assessment to estimate the risk of increased intracranial pressure after traumatic brain injury in prehospital setting. Prehosp Emerg Care. 2019;11:1-2. 5. De Bernardo M, Rosa N. Transbulbar B-mode sonography in multiple sclerosis: clinical and biological relevance. Ultrasound Med Biol. 2018;44:508. 6. De Bernardo M, Marotta G, Rosa N. Sonography of the optic nerve sheath diameter. J Ultrasound Med. 2018;37:1845. 7. De Bernardo M, Rosa N. Transorbital sonography to evaluate optic nerve in hypertensive encephalopathy. J Stroke Cerebrovasc Dis. 2018;27:1124. 8. Tenuta M, De Bernardo M, Rosa N. Comments on "Neuromuscular ultrasonography of cranial nerves." J Clin Neurol. 2017;13:212-213. 9. De Bernardo M, Rosa N. Measuring optic nerve sheath diameter as a proxy for intracranial pressure. JAMA Ophthalmol. 2018;136:1309-1310. Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema: Response W e thank Drs. De Bernardo, Vitiello, and Rossa for their comments regarding the use of ultrasound to follow patients with idiopathic intracranial hypertension (IIH). Our article did not address the follow-up of such patients. The resolution of papilledema with improvement of vision serves as the standard for determining efficacy of treatment in most patients with IIH. In patients without papilledema, assessing a response to treatment is more challenging. Data from the Idiopathic Intracranial Hypertension Treatment Trial showed that headache disability in IIH was not greater among those with higher cerebrospinal fluid pressure or papilledema grade at baseline or at 6 months (1). This suggests a need for comprehensive headache treatments in these patients. We advise against treatment of imaging findings if clinical features suggest improvement. Robert M. Mallery, MD Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts Letters to the Editor: J Neuro-Ophthalmol 2019; 39: 437-439 10. Rosa N, De Bernardo M. Ultrasound assessment of optic nerve sheath diameter in healthy volunteers. J Crit Care. 2017;40:279. 11. De Bernardo M, Rosa N. Optic nerve sheath diameter measurement in patients with idiopathic normal-pressure hydrocephalus. Eur J Neurol. 2018;25:e24. 12. De Bernardo M, Rosa N. Comment on "Invasive and non invasive means of measuring intracranial pressure: a review." Physiol Meas. 2018;39:058001. 13. De Bernardo M, Vitiello L, Rosa N. Optic nerve sheath diameter ultrasonography in differentiation of ischemic and hemorrhagic strokes. Am J Emerg Med. 2019;37:1384-1385. 14. De Bernardo M, Rosa N. Comment on "optic nerve sheath diameter ultrasound evaluation in intensive care unit: possible role and clinical aspects in neurological critical Patients' daily monitoring." Biomed Res Int. 2018;2018:6154357. 15. Iaconetta G, De Bernardo M, Rosa N. Coronal axis measurements of the optic nerve sheath diameter. J Ultrasound Med. 2017;36:1073. Deborah I. Friedman, MD, MPH Departments of Neurology and Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas Kathleen B. Digre, MD Departments of Ophthalmology and Neurology, University of Utah School of Medicine, Salt Lake City, Utah Grant T. Liu, MD Department of Ophthalmology, University of Pennsylvania Scheie Eye Institute, Philadelphia, Pennsylvania Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania The authors report no conflicts of interest. REFERENCE 1. Friedman DI, Quiros PA, Subramanian PS, Mejico LJ, Gao S, McDermott M, Wall M; the NORDIC IIHTT Study Group. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache 2017;57:1195-1205. 439 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.