Several findings on the MRI are suggestive of pseudotumor cerebri including an enlarged and elongated subarachnoid space around the optic nerve. However the definitive diagnosis is chronically elevated cerebrospinal fluid pressure. My understanding of the literature (I am an ophthalmologist not a radiologist) is that you could have pseudotumor cerebri and have a normal appearing MRI.
Optic neuritis and pseudotumor are hard to compare because optic neuritis has so many different clinical presentations from a rapidly progressing loss of vision with severe pain to a subclinical optic neuritis that the patient is totally unaware of and that may leave so little damage it's hard to detect.
The earliest sign of pseudotumor in the eyes is momentary loss of vision often when bending over then raising back up. Left untreated or undetected pseudotumor can cause loss of some or even loss of vision in one or both eyes.
Pseudotumor may progress fast in some people, slow in others. The main problem is diagnosis. Once pseudotumor is diagnosed most cases can be controled with medication or in the most severe cases by an operation to make a small hole in the covering of the optic nerve to allow the excess pressure to shunt the cerebralspinal fluid into the space behind the eye (retrobulbar orbit)
JCH MD Eye Physician & Surgeon