Optic nerve head damage relation to intracranial pressure and corneal properties of eye in glaucoma risk assessment

Abstract Background Idiopathic intracranial hypertension (IIH) is a headache syndrome due to raised intracranial pressure of unknown etiology. Before making the diagnosis of IIH, secondary causes of raised intracranial pressure must be ruled out. The radiological features associated with this condition have variable sensitivity and specificity. In this case series, we aim to describe a potential new radiological marker of IIH, that is, diffusion restriction, in the optic disc head and propose that this can be a specific finding in the appropriate clinical picture. Importance IIH causes vision loss and disabling daily headaches. The diagnosis of this condition is based on history and physical examination findings. Magnetic resonance imaging (MRI) is used to exclude other causes, but specific radiological markers for the diagnosis of IIH are lacking. Observations Five patients presented with the main complaint of headache, which was associated with blurry vision. All of our patients had a formal neuro-ophthalmological evaluation that confirmed the presence of optic disc edema in both eyes. They also underwent an MRI of the brain that showed diffusion restriction in the optic nerve head in either eye or both eyes. Patients underwent lumbar puncture in the lateral decubitus position, which revealed cerebrospinal fluid opening pressures > 25 cm H2O. They all responded well to standard treatments, with the resolution of symptoms in their follow-up appointments. Conclusion and Relevance The MRI diffusion restriction in the optic nerve head may be a reliable noninvasive marker for the diagnosis of IIH in the appropriate clinical picture.

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Optic Nerve Sonography in the Diagnostic Evaluation of Pseudopapilledema and Raised Intracranial Pressure: A Cross-Sectional Study

Neurology Research International ◽

10.1155/2015/146059 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Masoud Mehrpour ◽

Fatemeh Oliaee Torshizi ◽

Shooka Esmaeeli ◽

Salameh Taghipour ◽

Sahar Abdollahi

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Head ◽

Cross Sectional Study ◽

Optic Disk ◽

Sectional Study ◽

Cross Sectional ◽

Nerve Sheath ◽

Nerve Sonography ◽

Optic Nerve Sonography

Introduction. Differentiating pseudopapilledema from papilledema which is optic disk edema and a result of increased ICP (intracranial pressure) is important and can be done with noninvasive methods like orbital ultrasound examination.Method. This was a cross-sectional study in which patients with optic nerve head swelling were referred for LP exam after optic nerve head swelling diagnosis confirmation and having normal brain imaging (CT scan). Before LP (lumbar puncture) exam the patients were referred for optic nerve ultrasound test of both eyes.Results. Considering 5.7 mm as the upper limit for normal ONSD (optic nerve sheath diameter), sensitivity and negative predictive value of optic sonography in diagnosis of pseudopapilledema are 100% for both eyes. Calculated accuracy validity of ONSD measurement in detecting pseudopapilledema is 90% for the right eye and 87% for the left eye.Conclusion. Our study demonstrated a close correlation between optic nerve sheath dilation on ocular ultrasound and evidence of elevated ICP with optic disk swelling. With the aid of noninvasive diagnostic tests we can avoid unnecessary concerns along with expensive and invasive neurological investigations while targeting the correct diagnosis in bilateral optic disk swelling. Our study showed optic nerve sonography as a reliable diagnostic method for further usage.

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The Manifestation of the Optic Nerve Head Under Simultaneous Intraocular Pressure and Intracranial Pressure Elevation

Advances in Visual Science and Eye Diseases - Optic Disorders and Visual Field ◽

10.1007/978-981-13-2502-1_60 ◽

2019 ◽

pp. 585-592

Author(s):

Xiaobin Xie ◽

Ningli Wang

Keyword(s):

Intraocular Pressure ◽

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Head ◽

Pressure Elevation ◽

Intracranial Pressure Elevation

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Retinal Vein Changes as a Biomarker to Guide Diagnosis and Management of Elevated Intracranial Pressure

Frontiers in Neurology ◽

10.3389/fneur.2021.751370 ◽

2021 ◽

Vol 12 ◽

Author(s):

Heather E. Moss

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Head ◽

Venous Pressure ◽

Fluid Pressure ◽

Elevated Intracranial Pressure ◽

Venous Outflow ◽

Non Invasive ◽

Clinical Measurements ◽

Cerebral Venous Pressure

Retinal vein changes, which can be observed on clinical exam or ophthalmic imaging, are promising non-invasive biomarkers for elevated intracranial pressure (ICP) as a complement to other markers of high ICP including optic nerve head swelling. Animal and human studies have demonstrated increase in retinal vein pressure associated with elevated ICP mediated by increase in cerebral venous pressure, compression of venous outflow by elevated cerebral spinal fluid pressure in the optic nerve sheath, and compression of venous outflow by optic nerve head swelling. Retinal vein pressure can be estimated using ophthalmodynamometry. Correlates of retinal vein pressure include spontaneous retinal venous pulsations, retinal vein diameter, and retinal vein tortuosity. All of these have potential for clinical use to diagnose and monitor elevated ICP. Challenges include diagnostic prediction based on single clinical measurements and accurate assessment of retinal vein parameters in cases where optic nerve head swelling limits visualization of the retinal veins.

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Intracranial Pressure Influences the Behavior of the Optic Nerve Head

Journal of Biomechanical Engineering ◽

10.1115/1.4035406 ◽

2017 ◽

Vol 139 (3) ◽

Cited By ~ 11

Author(s):

Yi Hua ◽

Junfei Tong ◽

Deepta Ghate ◽

Sachin Kedar ◽

Linxia Gu

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Head ◽

Neural Tissue ◽

Lamina Cribrosa ◽

Patient Specific ◽

Orthogonal Experimental Design ◽

Ischemic Optic Neuropathy ◽

Pia Mater ◽

Minimal Impact

In this work, the biomechanical responses of the optic nerve head (ONH) to acute elevations in intracranial pressure (ICP) were systematically investigated through numerical modeling. An orthogonal experimental design was developed to quantify the influence of ten input factors that govern the anatomy and material properties of the ONH on the peak maximum principal strain (MPS) in the lamina cribrosa (LC) and postlaminar neural tissue (PLNT). Results showed that the sensitivity of ONH responses to various input factors was region-specific. In the LC, the peak MPS was most strongly dependent on the sclera thickness, LC modulus, and scleral canal size, whereas in the PLNT, the peak MPS was more sensitive to the scleral canal size, neural tissue modulus, and pia mater modulus. The enforcement of clinically relevant ICP in the retro-orbital subarachnoid space influenced the sensitivity analysis. It also induced much larger strains in the PLNT than in the LC. Moreover, acute elevation of ICP leads to dramatic strain distribution changes in the PLNT, but had minimal impact on the LC. This work could help to better understand patient-specific responses, to provide guidance on biomechanical factors resulting in optic nerve diseases, such as glaucoma, papilledema, and ischemic optic neuropathy, and to illuminate the possibilities for exploiting their potential to treat and prevent ONH diseases.

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