MRI Head MRI of the head may be useful for initial evaluation of the child presenting with papilledema and signs of raised intracranial pressure by detecting an intracranial space occupying lesion or hydrocephalus. MRI is more useful than CT because of its ability to provide a higher soft tissue contrast resolution of intracranial structures [42,43]. MRI can also aid in the diagnosis of IIH by demonstrating a finding of partially empty sella. However, other imaging findings of IIH are better evaluated on MRI of the orbits. Administration of IV contrast can help in characterization of the intracranial space occupying lesion (when detected). MRI Orbits There is no relevant literature to support the use of MRI orbits alone in the initial evaluation of children with papilledema or suspected raised intracranial pressure. MRV Head MRV of the head may be useful in demonstrating narrowing of the distal transverse sinuses, which is supportive of the diagnosis of IIH. It may also be helpful in excluding cerebral venous sinus thrombosis, which may be a cause of secondary pseudotumor cerebri, especially in nonobese prepubertal children and individuals at high risk of cerebral venous sinus thrombosis [42,43]. Variant 7: Child. Suspected orbital or periorbital infection. Initial imaging. This variant consists of children presenting with signs of orbital infection. These include preseptal cellulitis (when infection is confined to eyelids and soft tissues anterior to the orbital septum), postseptal cellulitis, and orbital abscess. Preseptal cellulitis is usually caused by percutaneous introduction of the infectious pathogen or secondary to sinusitis or odontogenic in origin. Postseptal cellulitis is usually secondary to sinusitis (particularly ethmoid sinusitis) [44,45]. Infection of the postseptal space may have various catastrophic complications including raised
Orbital Imaging and Vision Loss Child. MRI Head MRI of the head may be useful for initial evaluation of the child presenting with papilledema and signs of raised intracranial pressure by detecting an intracranial space occupying lesion or hydrocephalus. MRI is more useful than CT because of its ability to provide a higher soft tissue contrast resolution of intracranial structures [42,43]. MRI can also aid in the diagnosis of IIH by demonstrating a finding of partially empty sella. However, other imaging findings of IIH are better evaluated on MRI of the orbits. Administration of IV contrast can help in characterization of the intracranial space occupying lesion (when detected). MRI Orbits There is no relevant literature to support the use of MRI orbits alone in the initial evaluation of children with papilledema or suspected raised intracranial pressure. MRV Head MRV of the head may be useful in demonstrating narrowing of the distal transverse sinuses, which is supportive of the diagnosis of IIH. It may also be helpful in excluding cerebral venous sinus thrombosis, which may be a cause of secondary pseudotumor cerebri, especially in nonobese prepubertal children and individuals at high risk of cerebral venous sinus thrombosis [42,43]. Variant 7: Child. Suspected orbital or periorbital infection. Initial imaging. This variant consists of children presenting with signs of orbital infection. These include preseptal cellulitis (when infection is confined to eyelids and soft tissues anterior to the orbital septum), postseptal cellulitis, and orbital abscess. Preseptal cellulitis is usually caused by percutaneous introduction of the infectious pathogen or secondary to sinusitis or odontogenic in origin. Postseptal cellulitis is usually secondary to sinusitis (particularly ethmoid sinusitis) [44,45]. Infection of the postseptal space may have various catastrophic complications including raised