Article
Optic nerve sheath diameter changes from supine to upright position in patients with spontaneous intracranial hypotension in a controlled analysis: a new ultrasound tool for diagnosis and follow-up?
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Authors
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Jens Fichtner
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
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Christian T. Ulrich
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
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Astrid Jilch
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
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Phillippe Schucht
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
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Felix Schlachtetzki
- Universitätsklinik für Neurologie, Bezirksklinikum Regensburg, Universität Regensburg
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Andreas Raabe
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
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Jürgen Beck
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern
| Published: | June 2, 2015 |
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Outline
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Objective: Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid (CSF) leaking, mostly in the spine. We hypothesize that there is a decrease of the optic nerve sheath diameter (ONSD) during positional changes from supine to upright position in patients with current orthostatic headache (OH).
Method: Transorbital B-mode ultrasound was performed employing a high-frequency transducer for ONSD measurements in the supine and then the upright position. Absolute values and changes of ONSD from supine to upright were assessed. In the primary analysis, we compared SIH patients with or without OH at the time of the assessment. Further analyses included subjects without a SIH diagnosis.
Results: Ultrasound was performed in 39 SIH patients, 18 with OH and 21 without OH, and in 39 control subjects in the same age range: 20 from our clinic, and 19 from a different institution. In supine position, mean ONSD (± s.d.) was similar in patients with (5.38 ± 0.91 mm) or without OH (5.48 ± 0.89 mm; P=0.921). In upright position, there was a significant difference in mean ONSD between patients with (4.84 ± 0.99 mm) and without OH (5.53 ± 0.99 mm; P=0.044).
The change in ONSD from supine to upright position differed significantly between SIH patients with (-0.53 ± 0.34 mm) or without OH (0.05 ± 0.41 mm; P<0.001). This change in ONSD was also statistically significant in a comparison of SIH patients with OH versus the rest of the patients (0.01 ± 0.38 mm; P<0.001; AUC: 0.874 in ROC analysis).
Conclusions: Symptomatic patients with SIH showed a significant decrease of ONSD when changing from the supine to the upright position as assessed by ultrasound. Ultrasound assessment of the ONSD in two positions may be a novel, non-invasive tool for the diagnosis and follow-up of SIH and for elucidating the pathophysiology of SIH.
