Superior cervical sympathetic ganglion enlargement in idiopathic intracranial hypertension: An exploratory case-control study.

AimIdiopathic intracranial hypertension (IIH) may involve bidirectional interactions between elevated intracranial pressure (ICP) and sympathetic nervous system activity along an ICP-sympathetic axis. We hypothesized that superior cervical sympathetic ganglion (SCG) volume is increased in IIH and investigated whether SCG enlargement on MRI may serve as a potential imaging covariate of disease severity associated with cerebrospinal fluid opening pressure (OP).MethodsIn this retrospective case control study, we selected IIH patients with a brain MRI within six weeks prior to lumbar puncture, and control participants with normal MRIs. We measured bilateral SCG volumes on MRI, and performed group comparisons and linear regression analyses.ResultsThirty-six IIH patients and 36 controls were included. Median OP in IIH was 24.5 cmH2O. Right, but not left, SCG volume was greater in IIH than controls (281 vs. 208 mm3, P = 0.038; BMI-adjusted P = 0.032). Combined bilateral SCG volume was also increased (631 vs. 381 mm3, P = 0.030; BMI-adjusted P = 0.026). A right SCG cutoff of ≥442 mm3 discriminated elevated OP (AUC = 0.713, optimal point for OP = 37.5 cmH2O) and was associated with increased odds of elevated OP (12.11, P = 0.016).ConclusionSCG enlargement may provide a potential imaging covariate for disease severity. However, given the exploratory nature of this investigation, future validation studies will determine its value in clinical decision-making and longitudinal assessment.