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Distinct neuroimaging findings are associated with IH, yet their discriminative power, reversibility and factors favoring normalization in prospective CVT patients are unknown. We determined test performance measures of neuroimaging signs in acute CVT patients, their longitudinal change under anticoagulation, association with IH at baseline and with recanalization at follow-up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We included 26 consecutive acute CVT patients and 26 healthy controls. Patients were classified as having IH based on CSF pressure\u2009&gt;\u200925 cmH<jats:sub>2<\/jats:sub>O and\/or papilledema on ophthalmological examination or ocular MRI. We assessed optic nerve sheath diameter (ONSD), optic nerve tortuousity, bulbar flattening, lateral and IV<jats:sup>th<\/jats:sup> ventricle size, pituitary configuration at baseline and follow-up, and their association with IH and venous recanalization.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>46% of CVT patients had IH. ONSD enlargement\u2009&gt;\u20095.8\u00a0mm, optic nerve tortuousity and pituitary grade\u2009\u2265\u2009III had highest sensitivity, ocular bulb flattening and pituitary grade\u2009\u2265\u2009III highest specificity for IH. Only ONSD reliably discriminated IH at baseline. Recanalization was significantly associated with regressive ONSD and pituitary grade. Other neuroimaging signs tended to regress with recanalization. After treatment, 184.9\u2009\u00b1\u200944.7\u00a0days after diagnosis, bulbar flattening resolved, whereas compared with controls ONSD enlargement (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and partially empty sella (<jats:italic>p<\/jats:italic>\u2009=\u20090.017), among other indicators, persisted.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>ONSD and pituitary grading have a high diagnostic value in diagnosing and monitoring CVT-associated IH. Given their limited sensitivity during early CVT and potentially persistent alterations following IH, neuroimaging indicators can neither replace CSF pressure measurement in diagnosing IH, nor determine the duration of anticoagulation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00234-024-03363-6","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T06:02:51Z","timestamp":1714197771000},"page":"1161-1176","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis"],"prefix":"10.1007","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-3089","authenticated-orcid":false,"given":"Florian F.","family":"Schuchardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-7863","authenticated-orcid":false,"given":"Niklas","family":"L\u00fctzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0758-5120","authenticated-orcid":false,"given":"Sebastian","family":"K\u00fcchlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-8483","authenticated-orcid":false,"given":"Michael","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-5905","authenticated-orcid":false,"given":"Wolf A.","family":"Lagr\u00e8ze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3744-7304","authenticated-orcid":false,"given":"Hansj\u00f6rg","family":"Mast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4910-1414","authenticated-orcid":false,"given":"Matthias","family":"Weigel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6468-4526","authenticated-orcid":false,"given":"Stephan","family":"Meckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-4807","authenticated-orcid":false,"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-5714","authenticated-orcid":false,"given":"Cornelius","family":"Weiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3252-7910","authenticated-orcid":false,"given":"Andreas","family":"Harloff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5869-1110","authenticated-orcid":false,"given":"Theo","family":"Demerath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,27]]},"reference":[{"key":"3363_CR1","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1161\/STR.0b013e31820a8364","volume":"42","author":"G Saposnik","year":"2011","unstructured":"Saposnik G, Barinagarrementeria F, Brown RD et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association\/American Stroke Association. 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