Abstract
Objective
To assess if the bedside assessment of the optic nerve sheath diameter (ONSD) could identify elevated intracranial pressure (ICP) in patients suspected of having Idiopathic Intracranial Hypertension (IIH).
Methods
Single-center, prospective, rater- blinded study performed in a freestanding pediatric teaching hospital
Patients 12-18 years of age scheduled for an elective lumbar puncture with the suspicion of IIH were eligible to participate. ONSD was measured via ultrasonography (US) prior to performing a sedated, lumbar puncture for measuring CSF opening pressure. Abnormal measurements were predefined as: ONSD ≥ 4.5 mm and a CFS opening pressure > 20 cmH2O.
Results
13 patients participated in the study, ten of them with elevated ICP. ONSD was able to predict or ruled out elevated ICP in all patients.
Conclusions
Noninvasive assessment of the ONSD could be of value to identify patients with elevated ICP when IIH is suspected.
From the paper: The sedation of an often anxious and obese adolescent is not without risks. It is possible that further clinical follow up and response to treatment can be assessed using ONSD and avoid need of further lumber punctures. Although a relationship exists between increased ICP and ONSD but at this time ONSD cannot be solely used for diagnostic purpose. Our study highlights the need of a large, perhaps multi-center study with a control arm to validate the use of ONSD in the diagnostic work up of children with suspected IIH. It is not unforeseeable that in the near future the diagnosis of IIH may not require the direct measurement of an opening pressure obtained from an invasive lumbar puncture in a symptomatic patient but instead it could be identified through the use of non-invasive ultrasonography.
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