Diagnostic value of the optic nerve sheath subarachnoid space in patients with intracranial hypotension syndrome

2012 ◽  
Vol 117 (2) ◽  
pp. 372-377 ◽  
Author(s):  
Nobuyasu Takeuchi ◽  
Toru Horikoshi ◽  
Hiroyuki Kinouchi ◽  
Arata Watanabe ◽  
Takashi Yagi ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Subarachnoid Space ◽  
Intracranial Hypotension ◽  
Treatment Effectiveness ◽  
Spontaneous Intracranial Hypotension ◽  
Diagnostic Value ◽  
Optic Nerve Sheath ◽  
Csf Pressure ◽  
Nerve Sheath ◽  
Before And After

Object The size of the subarachnoid space in the optic nerve sheath (ONS) on MR images is thought to reflect intracranial pressure. The diagnostic value of this space was investigated in patients with spontaneous intracranial hypotension (SIH) syndrome. Methods Coronal fat-saturated T2-weighted MRI of the orbit was performed in 15 patients with SIH fulfilling the diagnostic criteria for headache caused by low CSF pressure of the International Classification of Headache Disorders or the criteria for spontaneous spinal CSF leaks and intracranial hypotension. The size of the subarachnoid space in the ONS was measured in 2 slices behind the eyeballs. The images were compared before and after treatment. The CSF pressure was measured by lumbar puncture. Results Before treatment, the diameter of the ONS subarachnoid space ranged from 2.58 to 4.21 mm (mean 3.34 mm) and the thickness from 0 to 0.48 mm (mean 0.15 mm). Both measurements showed significant correlations with CSF opening pressure, and 8 patients had no CSF space before treatment. The size of CSF space increased in many patients after effective treatment. Conclusions Disappearance of the CSF space in the ONS was frequently observed in patients with SIH. This characteristic finding may be useful in the diagnosis of SIH as well as in the evaluation of treatment effectiveness.

Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Jens Fichtner ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Debora Cipriani ◽  
Jan Gralla ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Sheath ◽  
Fluid Leak

Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (−0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.

scholarly journals Accuracy of Noninvasive Intraocular Pressure or Optic Nerve Sheath Diameter Measurements for Predicting Elevated Intracranial Pressure in Cryptococcal Meningitis

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Henry W. Nabeta ◽  
Nathan C. Bahr ◽  
Joshua Rhein ◽  
Nicholas Fossland ◽  
Agnes N. Kiragga ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Cryptococcal Meningitis ◽  
Optic Nerve Sheath Diameter ◽  
Diagnostic Value ◽  
Optic Nerve Sheath ◽  
Increased Intracranial Pressure ◽  
Nerve Sheath ◽  
Immunodeficiency Virus

Abstract Background.  Cryptococcal meningitis is associated with increased intracranial pressure (ICP). Therapeutic lumbar puncture (LP) is recommended when the initial ICP is &gt;250 mm H2O, yet the availability of manometers in Africa is limited and not always used where available. We assessed whether intraocular pressure could be a noninvasive surrogate predictor to determine when additional therapeutic LPs are necessary. Methods.  Ninety-eight human immunodeficiency virus-infected Ugandans with suspected meningitis (81% Cryptococcus) had intraocular pressure measured using a handheld tonometer (n = 78) or optic nerve sheath diameter (ONSD) measured by ultrasound (n = 81). We determined the diagnostic performance of these methods for predicting ICP vs a standard manometer. Results.  The median ICP was 225 mm H2O (interquartile range [IQR], 135–405 mm H2O). The median intraocular pressure was 28 mm Hg (IQR, 22–37 mm Hg), and median ultrasound ONSD was 5.4 mm (IQR, 4.95–6.1 mm). ICP moderately correlated with intraocular pressure (ρ = 0.45, P &lt; .001) and with ultrasound ONSD (ρ = 0.44, P &lt; .001). There were not discrete threshold cutoff values for either tonometry or ultrasound ONSD that provided a suitable cutoff diagnostic value to predict elevated ICP (&gt;200 mm H2O). However, risk of elevated ICP &gt;200 mm H2O was increased with an average intraocular pressure &gt;28 mm Hg (relative risk [RR] = 3.03; 95% confidence interval [CI], 1.55–5.92; P &lt; .001) or an average of ONSD &gt;5 mm (RR = 2.39; 95% CI, 1.42–4.03; P = .003). As either intraocular pressure or ONSD increased, probability of elevated ICP increased (ie, positive predictive value increased). Conclusions.  Noninvasive intraocular pressure measurements by tonometry or ultrasound correlate with cerebrospinal fluid opening pressure, but both are a suboptimal replacement for actual ICP measurement with a manometer.

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