Management of spontaneous intracranial hypotension - Transorbital ultrasound as discriminator.

Fichtner, Jens; Ulrich, Christian T.; Fung, Christian; Knüppel, Christin; Veitweber, Martina; Jilch, Astrid; Schucht, Philippe; Ertl, Michael; Schömig, Beate; Gralla, Jan; Z'Graggen, Werner Josef; Bernasconi, Corrado Angelo; Mattle, Heinrich; Schlachetzki, Felix; Raabe, Andreas; Beck, Jürgen (2015). Management of spontaneous intracranial hypotension - Transorbital ultrasound as discriminator. Journal of neurology, neurosurgery and psychiatry, 87(6), pp. 650-655. BMJ Publishing Group 10.1136/jnnp-2015-310853

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OBJECTIVE Spontaneous intracranial hypotension (SIH) is most commonly caused by cerebrospinal fluid (CSF) leakage. Therefore, we hypothesised that patients with orthostatic headache (OH) would show decreased optic nerve sheath diameter (ONSD) during changes from supine to upright position. METHODS Transorbital B-mode ultrasound was performed employing a high-frequency transducer for ONSD measurements in the supine and upright positions. Absolute values and changes of ONSD from supine to upright were assessed. Ultrasound was performed in 39 SIH patients, 18 with OH and 21 without OH, and in 39 age-matched control subjects. The control group comprised 20 patients admitted for back surgery without headache or any orthostatic symptoms, and 19 healthy controls. RESULTS In supine position, mean ONSD (±SD) was similar in patients with (5.38±0.91 mm) or without OH (5.48±0.89 mm; p=0.921). However, in upright position, mean ONSD was different between patients with (4.84±0.99 mm) and without OH (5.53±0.99 mm; p=0.044). Furthermore, the change in ONSD from supine to upright position was significantly greater in SIH patients with OH (-0.53±0.34 mm) than in SIH patients without OH (0.05±0.41 mm; p≤0.001) or in control subjects (0.01±0.38 mm; p≤0.001; area under the curve: 0.874 in receiver operating characteristics analysis). CONCLUSIONS Symptomatic patients with SIH showed a significant decrease of ONSD, as assessed by ultrasound, when changing from the supine to the upright position. 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Fichtner, Jens; Ulrich, Christian T.; Fung, Christian; Schucht, Philippe; Gralla, Jan; Z'Graggen, Werner Josef; Bernasconi, Corrado Angelo; Mattle, Heinrich; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3050

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

05 Oct 2015 09:45

Last Modified:

26 Jun 2016 02:07

Publisher DOI:

10.1136/jnnp-2015-310853

PubMed ID:

26285586

BORIS DOI:

10.7892/boris.72162

URI:

https://boris.unibe.ch/id/eprint/72162

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