Article
Non-invasive first-line and follow-up diagnostic of patients with idiopathic intracranial hypertension (IIH)
Nicht-invasive First-Line- und Follow-Up-Diagnostik von Patienten mit idiopathischer intrakranieller Hypertension (IIH)
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Authors
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Susanne R. Kerscher
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Pädiatrische Neurochirurgie, Tübingen, Deutschland
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Martin U. Schuhmann
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Pädiatrische Neurochirurgie, Tübingen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Idiopathic intracranial hypertension (IIH) is a disease associated with increased intracranial pressure (ICP) under absence of hydrocephalus or space-occupying lesion. For initial diagnosis and follow-up during/after medical, interventional or surgical treatment, repetitive invasive lumbar punctures are often necessary to evaluate therapy success. Combined ultrasound-based measurement of optic nerve sheath diameter (ONSD) and third ventricle Diameter (TVD) are an ideal first-line tool, to diagnose possible ICP increases and exclude hydrocephalus. After treatment, repetitive ONSD determination can be used for control of therapy success.
Methods: 12 adults (11 women, 1 man, age-range 22-49) and 17 children (16 boys, 1 girl, age-range 4-17) diagnosed with IIH were investigated. Ultrasound-based transorbital ONSD and transtemporal TVD measurements were performed initially and during the course of the disease repetitively. Individual ONSD values were compared to invasively measured ICP values to create individual ONSD-ICP-correlation-curves and calculate ICP values according to ONSD.
Results: Initial ONSD mean value was 5.95±0.34mm in the pediatric (normal values <5.3mm) and 6.15±0.41mm in adult (normal value <5.5mm) patients. TVD values were always below 5mm in children and adults, excluding hydrocephalus. After any kind of therapy mean ONSD decreased quickly and significantly (p<0.01) in the entire cohort and increased again with rising ICP. Intra-individual correlations of ONSD and ICP were outstandingly linear ( r=0.66- 0.99, p<0.01).
Conclusion: Combined ultrasound-based ONSD and TVD measurement is an optimal first-line screening tool for IIH in pediatric and adult patients. ONSD can detect ICP increase, TVD can exclude hydrocephalus as underlying reason. Repeated ONSD measurements during IIH therapy can be used for control of therapy effectiveness as ONSD values quickly decrease after therapy and increase in case of therapy failure. Thus repeated lumbar punctures can be avoided.
