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Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J Clin Med 2023; 12:jcm12062209. [PMID: 36983213 PMCID: PMC10051320 DOI: 10.3390/jcm12062209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: Intracranial pressure (ICP) monitoring plays a key role in the treatment of patients in intensive care units, as well as during long-term surgeries and interventions. The gold standard is invasive measurement and monitoring via ventricular drainage or a parenchymal probe. In recent decades, numerous methods for non-invasive measurement have been evaluated but none have become established in routine clinical practice. The aim of this study was to reflect on the current state of research and shed light on relevant techniques for future clinical application. (2) Methods: We performed a PubMed search for “non-invasive AND ICP AND (measurement OR monitoring)” and identified 306 results. On the basis of these search results, we conducted an in-depth source analysis to identify additional methods. Studies were analyzed for design, patient type (e.g., infants, adults, and shunt patients), statistical evaluation (correlation, accuracy, and reliability), number of included measurements, and statistical assessment of accuracy and reliability. (3) Results: MRI-ICP and two-depth Doppler showed the most potential (and were the most complex methods). Tympanic membrane temperature, diffuse correlation spectroscopy, natural resonance frequency, and retinal vein approaches were also promising. (4) Conclusions: To date, no convincing evidence supports the use of a particular method for non-invasive intracranial pressure measurement. However, many new approaches are under development.
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Affiliation(s)
- Sebastian Johannes Müller
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Correspondence: ; Tel.: +49-(0)711-278-34501
| | - Elina Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Matthew J. Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, MA 01655, USA
| | - Stephan Felber
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Stiftungsklinikum Mittelrhein, D-56068 Koblenz, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, D-47057 Duisburg, Germany
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Félix H, Oliveira ES. Non-Invasive Intracranial Pressure Monitoring and Its Applicability in Spaceflight. Aerosp Med Hum Perform 2022; 93:517-531. [DOI: 10.3357/amhp.5922.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Neuro-ophthalmic findings collectively defined as Spaceflight-Associated Neuro-ocular Syndrome (SANS) are one of the leading health priorities in astronauts engaging in long duration spaceflight or prolonged microgravity exposure. Though multifactorial in etiology,
similarities to terrestrial idiopathic intracranial hypertension (IIH) suggest these changes may result from an increase or impairing in intracranial pressure (ICP). Finding a portable, accessible, and reliable method of monitoring ICP is, therefore, crucial in long duration spaceflight. A
review of recent literature was conducted on the biomedical literature search engine PubMed using the search term “non-invasive intracranial pressure”. Studies investigating accuracy of noninvasive and portable methods were assessed. The search retrieved different methods that
were subsequently grouped by approach and technique. The majority of publications included the use of ultrasound-based methods with variable accuracies. One of which, noninvasive ICP estimation by optical nerve sheath diameter measurement (nICP_ONSD), presented the highest statistical correlation
and prediction values to invasive ICP, with area under the curve (AUC) ranging from 0.75 to 0.964. One study even considers a combination of ONSD with transcranial Doppler (TCD) for an even higher performance. Other methods, such as near-infrared spectroscopy (NIRS), show positive and promising
results [good statistical correlation with invasive techniques when measuring cerebral perfusion pressure (CPP): r = 0.83]. However, for its accessibility, portability, and accuracy, ONSD seems to present itself as the up to date, most reliable, noninvasive ICP surrogate and a valuable spaceflight
asset.Félix H, Santos Oliveira E. Non-invasive intracranial pressure monitoring and its applicability in spaceflight. Aerosp Med Hum Perform. 2022; 93(6):517–531.
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Hou Y, Liang H, Fan C, Liu R, Feng Y. Association of intraocular pressure and postoperative nausea and vomiting after microvascular decompression - a prospective cohort study. BMC Anesthesiol 2022; 22:132. [PMID: 35490219 PMCID: PMC9055703 DOI: 10.1186/s12871-022-01665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting is common in patients receiving microvascular decompression. In the current study, we examined whether postoperative nausea and vomiting is associated with reduced intraocular pressure (IOP) after microvascular decompression, a measure that reflects intracranial pressure. METHODS This is a prospective cohort study. Adult patients scheduled for microvascular decompression surgery for hemifacial spasm between January 2020 and August 2020 were eligible. IOP was measured immediately before anesthesia induction and 30 min after patients regained complete consciousness using non-contact tonometry. IOP reduction was defined by at least 1 mmHg decrease vs. preoperative baseline. The primary outcome was vomiting on postoperative day 1. RESULTS A total of 103 subjects were enrolled. IOP was reduced in 56 (54.4%) subjects. A significantly greater proportion of patients with IOP reduction had vomiting on postoperative day 1 (51.8% (29/56) vs. 23.4% (11/47) in those without IOP reduction; p = 0.003). In the multivariate regression analysis, vomiting on postoperative day 1 was associated with female sex [odds ratio = 7.87, 95% CI: 2.35-26.32, p = 0.001] and IOP reduction [odds ratio = 2.93, 95% CI: 1.13-7.58, p = 0.027]. CONCLUSIONS In patients undergoing microvascular decompression surgery, postoperative IOP reduction is associated with postoperative vomiting. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000029083 . Registered 13 January 2020.
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Affiliation(s)
- Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Cungang Fan
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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Onder H. The association between intraocular pressure and intracranial pressure in patients with hydrocephalus? Int J Neurosci 2020; 131:518-519. [PMID: 32202182 DOI: 10.1080/00207454.2020.1746305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey
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Mekjavic IB, Amoaku W, Mlinar T, Jaki Mekjavic P. Hypercapnia augments resistive exercise-induced elevations in intraocular pressure in older individuals. Exp Physiol 2020; 105:641-651. [PMID: 32034962 DOI: 10.1113/ep088236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/07/2020] [Indexed: 12/13/2022]
Abstract
NEW FINDINGS What is the central question of this study? Astronauts on-board the International Space Station (ISS) perform daily exercises designed to prevent muscle atrophy and bone demineralization: what is the effect of resistive exercise performed by subjects while exposed to the same level of hypercapnia as on the ISS on intraocular pressure (IOP)? What is the main finding and its importance? The static exercise-induced elevation in IOP during 6° prone head-down tilt (simulating the headward shift of body fluids in microgravity) is augmented by hypercapnia and exceeds the ocular hypertension threshold. ABSTRACT The present study assessed the effect of 6° head-down (establishing the cephalad fluid displacement noted in astronauts in microgravity) prone (simulating the effect on the eye) tilt during rest and exercise (simulating exercise performed by astronauts to mitigate the sarcopenia induced by unloading of weight-bearing limbs), in normocapnic and hypercapnic conditions (the latter simulating conditions on the International Space Station) on intraocular pressure (IOP). Volunteers (mean age = 57.8 ± 6 years, n = 10) participated in two experimental sessions, each comprising: (i) 10 min rest, (ii) 3 min static handgrip exercise (30% max), and (iii) 2 min recovery, inspiring either room air (NCAP) or a hypercapnic mixture (1% CO2 , HCAP). We measured IOP in the right eye, cardiac output (CO), stroke volume (SV), heart rate (HR) and mean arterial pressure (MAP) at regular intervals. Baseline IOP in the upright seated position while breathing room air was 14.1 ± 2.9 mmHg. Prone 6° head-down tilt significantly (P < 0.01) elevated IOP in all three phases of the NCAP (rest: 27.0 ± 3.7 mmHg; exercise: 32.2 ± 4.8 mmHg; recovery: 27.4 ± 4.0 mmHg) and HCAP (rest: 27.3 ± 4.3 mmHg; exercise: 34.2 ± 6.0 mmHg; recovery: 29.1 ± 5.8 mmHg) trials, with hypercapnia augmenting the exercise-induced elevation in IOP (P < 0.01). CO, SV, HR and MAP were significantly increased during handgrip dynamometry, but there was no effect of hypercapnia. The observed IOP measured during prone 6° HDT in all phases of the NCAP and HCAP trials exceeded the threshold pressure defining ocular hypertension. The exercise-induced increase in IOP is exacerbated by hypercapnia.
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Affiliation(s)
- Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Jamova 39, Ljubljana, SI-1000, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, V51 1S6, Canada
| | - Winfried Amoaku
- Nottingham Eye Research Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Tinkara Mlinar
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Jamova 39, Ljubljana, SI-1000, Slovenia.,International Postgraduate School Jozef Stefan, Jamova 39, Ljubljana, SI-1000, Slovenia
| | - Polona Jaki Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Jamova 39, Ljubljana, SI-1000, Slovenia.,Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, Ljubljana, SI-1000, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, SI-1000, Slovenia
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Wang W, Wang M, Li Z, Wang T, Da R. The intraocular pressure could not be used to determine the intracranial pressure in patients with hydrocephalus. Int J Neurosci 2018; 129:42-48. [PMID: 29883235 DOI: 10.1080/00207454.2018.1486832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE An accurate intracranial pressure (ICP) measurement is vital for patients with hydrocephalus. ICP is generally measured by lumbar puncture opening pressure, which is invasive and has potential adverse side effects. Intraocular pressure (IOP) was investigated to measure ICP indirectly; however, its accuracy was controversial. We conducted this retrospective study to investigate whether IOP can be used as a surrogate for ICP in hydrocephalus patients. METHODS We performed a retrospective study enrolled 50 cases, including 32 patients with normal pressure hydrocephalus (NPH) and 18 patients with high pressure hydrocephalus (HPH). The independent factors of ICP, the correlation between ICP and other factors, and diagnostic value of IOP and papilledema to predict ICP were analysed, respectively. RESULTS Patients with HPH were more likely suffered from visual deterioration (33.33% vs. 9.38%, p = .045) and papilledema (55.56% vs. 3.13%, p = .001). Multivariate analysis revealed that papilledema was a significant factor (OR =40.765, 95%CI 3.331-498.846, p = .004). Pearson's correlation analysis indicated that ICP did not correlate with any other factors. CONCLUSIONS IOP was not an independent factor of ICP in patients with hydrocephalus, and could not be used to determine IOP. Papilledema might be a significant factor of ICP in hydrocephalus sufferers. Compared with NPH patients, patients with HPH were more prone to develop papilledema.
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Affiliation(s)
- Wei Wang
- a Department of Neurosurgery , The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , People's Republic of China
| | - Maode Wang
- a Department of Neurosurgery , The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , People's Republic of China
| | - Zhijin Li
- a Department of Neurosurgery , The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , People's Republic of China
| | - Tuo Wang
- a Department of Neurosurgery , The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , People's Republic of China
| | - Rong Da
- b Department of Clinical Laboratory , The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , People's Republic of China
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Jóhannesson G, Eklund A, Lindén C. Intracranial and Intraocular Pressure at the Lamina Cribrosa: Gradient Effects. Curr Neurol Neurosci Rep 2018; 18:25. [PMID: 29651628 PMCID: PMC5897485 DOI: 10.1007/s11910-018-0831-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW A pressure difference between the intraocular and intracranial compartments at the site of the lamina cribrosa has been hypothesized to have a pathophysiological role in several optic nerve head diseases. This paper reviews the current literature on the translamina cribrosa pressure difference (TLCPD), the associated pressure gradient, and its potential pathophysiological role, as well as the methodology to assess TLCPD. RECENT FINDINGS For normal-tension glaucoma (NTG), initial studies indicated low intracranial pressure (ICP) while recent findings indicate that a reduced ICP is not mandatory. Data from studies on the elevated TLCPD as a pathophysiological factor of NTG are equivocal. From the identification of potential postural effects on the cerebrospinal fluid (CSF) communication between the intracranial and retrolaminar space, we hypothesize that the missing link could be a dysfunction of an occlusion mechanism of the optic nerve sheath around the optic nerve. In upright posture, this could cause an elevated TLCPD even with normal ICP and we suggest that this should be investigated as a pathophysiological component in NTG patients.
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Affiliation(s)
- Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden. .,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
| | - Anders Eklund
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Christina Lindén
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
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Transorbital Sonographic Evaluation of Optic Nerve Sheath Diameter in Normal Hong Kong Chinese Adults. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To establish the range of normal values of optic nerve sheath diameter (ONSD) measured by bedside ocular ultrasonography (USG) in Hong Kong Chinese adults. Design and methods This was a prospective study conducted between May and June 2007 in the Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital. Subjects without neurological and ophthalmologic complaint were recruited by convenience sampling. The ONSD of both eyes were measured 3 mm behind the globe using a 7.5 MHz linear probe on the closed eyelids of supine subjects. Repeated measurements (n=4) were carried out for every optic nerve to control the variability of this scanning procedure. Range, mean values and standard deviations were calculated. Results One hundred subjects were recruited to the study. The range for ONSD was from 3.7 mm to 4.7 mm with a mean of 4.05 mm and standard deviation (SD) of 0.19 mm. There were no significant differences in ONSD measurement between males and females (p=0.44), between right and left eye (p=0.83) or between volunteer AED staff and recruited patients (p=0.10). The differences among different age groups (p=0.13) and the correlation between age and ONSD with r=0.19 (p=0.05) were not significant. Conclusion Our results suggest that the range of ONSD in normal Hong Kong Chinese adults is between 3.7 mm and 4.7 mm which is similar to the finding in previous literatures. This study also suggests that bedside ocular USG is a convenient and useful tool in measuring ONSD and the application of this technique is acceptable by patients in our locality.
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Liugan M, Xu Z, Zhang M. Reduced Free Communication of the Subarachnoid Space Within the Optic Canal in the Human. Am J Ophthalmol 2017; 179:25-31. [PMID: 28455115 DOI: 10.1016/j.ajo.2017.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Recent studies in patients demonstrated that cerebrospinal fluid does not flow continuously between the intracranial subarachnoid space (SAS) and the space around the optic nerve in the orbit. Its anatomic basis remains elusive. The objective of this study was to use a novel anatomic technology, the epoxy sheet plastination, to reveal the configuration of the fibrous structures within the optic canal and their relationship with the optic nerve, SAS, and ophthalmic artery. DESIGN A human cadaveric study. METHODS Nine cadaveric heads (subject age 54-87 years) without optic neuropathy were prepared as sets of transverse, coronal, and sagittal plastinated sections. Three of them were pretreated with hematoxylin staining via the SAS irrigation before sectioning and plastination. The prepared sections were examined under a stereoscope and a confocal microscope. RESULTS The results showed that (1) the pia and arachnoid maters merged within the optic canal, (2) a dense trabecular mesh network was distributed in the orbital part of the canal, and (3) some optic nerve sheath (ONS) fibers intermingled with the tendinous fibers of the extraocular muscles and attached to the periosteum of the sphenoid bone, rather than entirely continuing with the inner layer of the dura mater. CONCLUSIONS This study identified and traced the fibrous components within the optic canal and revealed their nature, architecture, and relationship with surroundings and concluded that in the human, free communication of the SAS between the intracranial cavity and ONS was significantly reduced.
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Abstract
Assessing intracranial pressure (ICP) remains a cornerstone in neurosurgical care. Invasive techniques for monitoring ICP remain the gold standard. The need for a reliable, safe and reproducible technique to non-invasively assess ICP in the context of early screening and in the neurocritical care environment is obvious. Numerous techniques have been described with several novel advances. While none of the currently available techniques appear independently accurate enough to quantify raised ICP, there is some promising work being undertaken.
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The Effect of Body Position on Intraocular and Intracranial Pressure in Rabbits. ACTA NEUROCHIRURGICA. SUPPLEMENT 2016; 122:279-82. [PMID: 27165921 DOI: 10.1007/978-3-319-22533-3_55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The correlation between cerebrospinal fluid (CSF) and intraocular pressure (IOP) is still unclear. We compared CSF and IOP measured by the same invasive technique using a new experimental model in rabbits during changes of body position. METHODS Pressure changes were recorded in the lateral ventricle (LV), the cortical subarachnoid space (CSS), and the anterior ocular chamber of anesthetized rabbits (n = 12). Animals and measuring instruments were both fixed on a board at an adequate hydrostatic level. RESULTS In a horizontal position, control IOP (15.1 ± 1.6 cmH2O) and CSF pressure in the LV (12.4 ± 0.6 cmH2O) and CSS (12.2 ± 0.9 cmH2O) were similar during the 60-min period. When changing the body position from horizontal to vertical (upright), CSF pressures decreased drastically (LV = -5.5 ± 2.6 cmH2O and CSS = -7.7 ± 2.3 cmH2O), while the IOP decreased moderately (IOP = 13.3 ± 0.5 cmH2O). CONCLUSION Change in body position from horizontal to vertical causes drastic changes in CSF pressure and moderate changes in IOP. Thus, IOP is not reflected by the CSF pressure. In an upright position, the values of CSF pressure were equal to the hydrostatic distance between measuring points and the foramen magnum, which suggests that CSF pressure inside the cranium depends on its anatomical and biophysical features, and not on CSF secretion and absorption.
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Facts and myths of cerebrospinal fluid pressure for the physiology of the eye. Prog Retin Eye Res 2015; 46:67-83. [DOI: 10.1016/j.preteyeres.2015.01.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 01/19/2023]
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Siaudvytyte L, Januleviciene I, Ragauskas A, Bartusis L, Siesky B, Harris A. Update in intracranial pressure evaluation methods and translaminar pressure gradient role in glaucoma. Acta Ophthalmol 2015; 93:9-15. [PMID: 25043873 DOI: 10.1111/aos.12502] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/15/2014] [Indexed: 01/24/2023]
Abstract
Glaucoma is one of the leading causes of blindness worldwide. Historically, it has been considered an ocular disease primary caused by pathological intraocular pressure (IOP). Recently, researchers have emphasized intracranial pressure (ICP), as translaminar counter pressure against IOP may play a role in glaucoma development and progression. It remains controversial what is the best way to measure ICP in glaucoma. Currently, the 'gold standard' for ICP measurement is invasive measurement of the pressure in the cerebrospinal fluid via lumbar puncture or via implantation of the pressure sensor into the brains ventricle. However, the direct measurements of ICP are not without risk due to its invasiveness and potential risk of intracranial haemorrhage and infection. Therefore, invasive ICP measurements are prohibitive due to safety needs, especially in glaucoma patients. Several approaches have been proposed to estimate ICP non-invasively, including transcranial Doppler ultrasonography, tympanic membrane displacement, ophthalmodynamometry, measurement of optic nerve sheath diameter and two-depth transcranial Doppler technology. Special emphasis is put on the two-depth transcranial Doppler technology, which uses an ophthalmic artery as a natural ICP sensor. It is the only method which accurately and precisely measures absolute ICP values and may provide valuable information in glaucoma.
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Affiliation(s)
- Lina Siaudvytyte
- Eye Clinic Lithuanian University of Health Sciences Kaunas Lithuania
| | | | - Arminas Ragauskas
- Health Telematics Science Centre of Kaunas University of Technology Kaunas Lithuania
| | - Laimonas Bartusis
- Eye Clinic Lithuanian University of Health Sciences Kaunas Lithuania
- Health Telematics Science Centre of Kaunas University of Technology Kaunas Lithuania
| | - Brent Siesky
- Glaucoma Research and Diagnostic Center Eugene and Marilyn Glick Eye Institute Indiana University School of Medicine Indianapolis IN USA
| | - Alon Harris
- Eye Clinic Lithuanian University of Health Sciences Kaunas Lithuania
- Glaucoma Research and Diagnostic Center Eugene and Marilyn Glick Eye Institute Indiana University School of Medicine Indianapolis IN USA
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Yavin D, Luu J, James MT, Roberts DJ, Sutherland GR, Jette N, Wiebe S. Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis: a systematic review. J Neurosurg 2014; 121:680-7. [PMID: 24857243 DOI: 10.3171/2014.4.jns13932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Because clinical examination and imaging may be unreliable indicators of intracranial hypertension, intraocular pressure (IOP) measurement has been proposed as a noninvasive method of diagnosis. The authors conducted a systematic review and meta-analysis to determine the correlation between IOP and intracranial pressure (ICP) and the diagnostic accuracy of IOP measurement for detection of intracranial hypertension. METHODS The authors searched bibliographic databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials) from 1950 to March 2013, references of included studies, and conference abstracts for studies comparing IOP and invasive ICP measurement. Two independent reviewers screened abstracts, reviewed full-text articles, and extracted data. Correlation coefficients, sensitivity, specificity, and positive and negative likelihood ratios were calculated using DerSimonian and Laird methods and bivariate random effects models. The I(2) statistic was used as a measure of heterogeneity. RESULTS Among 355 identified citations, 12 studies that enrolled 546 patients were included in the meta-analysis. The pooled correlation coefficient between IOP and ICP was 0.44 (95% CI 0.26-0.63, I(2) = 97.7%, p < 0.001). The summary sensitivity and specificity for IOP for diagnosing intracranial hypertension were 81% (95% CI 26%-98%, I(2) = 95.2%, p < 0.01) and 95% (95% CI 43%-100%, I(2) = 97.7%, p < 0.01), respectively. The summary positive and negative likelihood ratios were 14.8 (95% CI 0.5-417.7) and 0.2 (95% CI 0.02-1.7), respectively. When ICP and IOP measurements were taken within 1 hour of another, correlation between the measures improved. CONCLUSIONS Although a modest aggregate correlation was found between IOP and ICP, the pooled diagnostic accuracy suggests that IOP measurement may be of clinical utility in the detection of intracranial hypertension. Given the significant heterogeneity between included studies, further investigation is required prior to the adoption of IOP in the evaluation of intracranial hypertension into routine practice.
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Golan S, Kurtz S, Mezad-Koursh D, Waisbourd M, Kesler A, Halpern P. Poor correlation between intracranial pressure and intraocular pressure by hand-held tonometry. Clin Ophthalmol 2013; 7:1083-7. [PMID: 23785230 PMCID: PMC3682855 DOI: 10.2147/opth.s38910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study is to provide data on the controversial issue of whether handheld measurements of intraocular pressure (IOP) are capable of accurately predicting elevated intracranial pressure (ICP) in patients undergoing lumbar puncture (LP). METHODS All patients over the age of 18 years who underwent an LP in the emergency or neurological departments at the Tel Aviv Medical Center for any reason between October 2007 and July 2010 were eligible to participate in this prospective observational pilot study. IOP was measured with the Tono-Pen XL while patients were in the supine position before undergoing LP. ICP was measured in the lateral recumbent position. ICP and bilateral IOP were measured, and the mean and maximum values of IOP were calculated. The association between ICP and each one of the four IOP measures was evaluated by the Pearson correlation coefficient. RESULTS Twenty-four patients (mean age 37.8 ± 15.8 years, ten males and 14 females) were enrolled. The reasons for their requiring an LP were headache (19/24 patients), evaluation for hemiparesis (2/24), cognitive deterioration (1/24), and seizures (2/24). Nine had elevated mean opening pressure (>20 cm H2O), six had an elevated mean IOP (>20 mmHg), and four of these six also had an elevated opening pressure. There was no significant correlation between the ICP measurements and any of the IOP measurements. CONCLUSION Handheld ocular tonometry has poor sensitivity and specificity for the prediction of increased ICP and is not an effective tool for screening for ICP in the ED or in the neurology department.
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Affiliation(s)
- Shani Golan
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Can Intraocular Pressure Measurements be Used to Screen for Elevated Intracranial Pressure in Emergency Department Patients? J Emerg Med 2012; 43:532-7. [DOI: 10.1016/j.jemermed.2010.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 01/06/2010] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
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Li Z, Yang Y, Lu Y, Liu D, Xu E, Jia J, Yang D, Zhang X, Yang H, Ma D, Wang N. Intraocular pressure vs intracranial pressure in disease conditions: a prospective cohort study (Beijing iCOP study). BMC Neurol 2012; 12:66. [PMID: 22862817 PMCID: PMC3444958 DOI: 10.1186/1471-2377-12-66] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/13/2012] [Indexed: 02/06/2023] Open
Abstract
Background The correlation between intracranial pressure (ICP) and intraocular pressure (IOP) is still controversial in literature and hence whether IOP can be used as a non-invasive surrogate of ICP remains unknown. The aim of the current study was to further clarify the potential correlation between ICP and IOP. Methods The IOP measured with Goldmann applanation tonometer was carried out on 130 patients whose ICP was determined via lumber puncture. The Pearson correlation coefficient between ICP and IOP was calculated, the fisher line discriminated analysis to evaluate the effectivity of using IOP to predict the ICP level. Results A significant correlation between ICP and IOP was found. ICP was correlated significantly with IOP of the right eyes (p < 0.001) and IOP of the left eyes (p = 0.001) and mean IOP of both eyes (p < 0.001), respectively. However, using IOP as a measurement to predict ICP, the accuracy rate was found to be 65.4%. Conclusion Our data suggested that although a significant correlation exists between ICP and IOP, caution needs to be taken when using IOP readings by Goldmann applanation tonometer as a surrogate for direct cerebrospinal fluid pressure measurement of ICP.
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Affiliation(s)
- Zhen Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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The Effect of Body Position on Intraocular and CSF Pressures in the Lateral Ventricle, and in Cortical and Lumbar Subarachnoid Spaces in Cats. ACTA NEUROCHIRURGICA SUPPLEMENTUM 2012; 114:357-61. [DOI: 10.1007/978-3-7091-0956-4_69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Firsching R, Müller C, Pauli SU, Voellger B, Röhl FW, Behrens-Baumann W. Noninvasive assessment of intracranial pressure with venous ophthalmodynamometry. Clinical article. J Neurosurg 2011; 115:371-4. [PMID: 21529131 DOI: 10.3171/2011.3.jns101275] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECT Venous ophthalmodynamometry is a technique used to register the pressure within the central retinal vein. Because the outflow of the central retinal vein is exposed to the intracranial pressure (ICP), the pressure of the central retinal vein may be correlated with the ICP. In the absence of adequate statistical evidence, the authors compared the pressure of the central retinal vein with results of simultaneous invasive monitoring of ICP in neurosurgical patients. METHODS The pressure within the central retinal vein was recorded in 102 patients, in whom invasive continuous monitoring of ICP had become necessary for various reasons, mostly because of suspected hydrocephalus and intracranial hemorrhage. RESULTS A highly significant correlation of the pressure in the central retinal vein and the intracranial cavity was confirmed statistically. An increased pressure of the central retinal vein indicated an elevated ICP, with a probability of 84.2%, whereas a normal pressure of the central retinal vein indicated a normal ICP in 92.8% of patients. Conclusions Venous ophthalmodynamometry is a valuable technique for the noninvasive assessment of ICP.
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Affiliation(s)
- Raimund Firsching
- Otto-von-Guericke-Universität Magdeburg, Universitätsklinikum Magdeburg A. ö. R., Klinik für Neurochirurgie, Magdeburg, Germany.
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Czarnik T, Gawda R, Kolodziej W, Latka D, Sznajd-Weron K, Weron R. Associations between intracranial pressure, intraocular pressure and mean arterial pressure in patients with traumatic and non-traumatic brain injuries. Injury 2009; 40:33-9. [PMID: 19135194 DOI: 10.1016/j.injury.2008.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 10/02/2008] [Accepted: 10/08/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anatomical proximity of the eye and the intracranial space is a fact but the existence of physiological and pathophysiological relationships between them is elusive. The objective of this study was to explore anatomical and pathophysiological interactions between the eye and the intracranial space and to assess clinical utility of intraocular pressure measurement in estimation of intracranial pressure in patients with brain injuries and to discover how haemodynamic instability could influence these interactions. Controversy surrounds the recent literature concerning this problem and the consensus has not been achieved. MATERIALS AND METHODS We evaluated the correlation between intracranial pressure and intraocular pressure, intracranial pressure and mean arterial pressure, intraocular pressure and mean arterial pressure in 40 patients with brain injuries initially comatose, admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous recordings of intracranial pressure, intraocular pressure and mean arterial pressure were performed. RESULTS We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient for all three relations. We found significant correlation between intraocular pressure and mean arterial pressure in 63% of the tested population. When the power of the test was increased, by considering only patients with 11 or more observations, this ratio increased to 76%. However, the correlation between intraocular pressure and intracranial pressure, as well as, between intracranial pressure and mean arterial pressure was not significant. CONCLUSIONS There is no anatomical and pathophysiological basis for the statement that intraocular pressure can be used as an indirect estimator of intracranial pressure.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anaesthesia and Critical Care, Regional Medical Centre, Aleja Witosa 26, 45-418 Opole, Poland.
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Czarnik T, Gawda R, Latka D, Kolodziej W, Sznajd-Weron K, Weron R. Noninvasive measurement of intracranial pressure: is it possible? ACTA ACUST UNITED AC 2007; 62:207-11. [PMID: 17215756 DOI: 10.1097/01.ta.0000219128.29515.d5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Some publications suggest a strong correlation between the intracranial pressure and the intraocular pressure. Other studies claim no correlation between these two physiologic variables. Our aim was to study whether the tonometry could be a useful method to evaluate intracranial pressure in patients with suspected intracranial abnormality. METHODS We evaluated the correlation between the intracranial pressure and the intraocular pressure, the intracranial pressure and the mean arterial pressure, and the intraocular pressure and the mean arterial pressure in 22 patients, initially comatose, who were admitted to our hospital. All patients required the intracranial pressure monitoring on clinical grounds. Simultaneous measurements were performed and recorded. RESULTS We calculated both the linear correlation coefficient and the Spearman rank-order correlation coefficient. We found significant correlation between the intraocular pressure and the mean arterial pressure in 12 patients; however, significant correlation between the intraocular pressure and the intracranial pressure was found in only 2 patients. CONCLUSION Tonometry is not an appropriate method for the assessment of intracranial pressure increases.
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Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesia and Critical Care, Regional Medical Center, Opole, Poland.
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Sajjadi SA, Harirchian MH, Sheikhbahaei N, Mohebbi MR, Malekmadani MH, Saberi H. The relation between intracranial and intraocular pressures: study of 50 patients. Ann Neurol 2006; 59:867-70. [PMID: 16634008 DOI: 10.1002/ana.20856] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We evaluated the correlation between intracranial (ICP) and intraocular pressure (IOP). METHODS Of the 77 patients who underwent a lumbar puncture, 27 were excluded secondary to a history of glaucoma, using drugs effective on IOP, and abnormal funduscopic examination. ICP was measured by lumbar puncture. IOP was measured by two scales of Schiotz tonometer in both eyes, and the mean was calculated. RESULTS We found a significant correlation between ICP and mean IOP (p < 0.001; r = 0.955). Body mass index, age, and disease type had no significant effect on this correlation. INTERPRETATION IOP is correlated with ICP.
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Affiliation(s)
- Seyed A Sajjadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Firsching R, Schütze M, Motschmann M, Behrens-Baumann W. Venous opthalmodynamometry: a noninvasive method for assessment of intracranial pressure. J Neurosurg 2000; 93:33-6. [PMID: 10883902 DOI: 10.3171/jns.2000.93.1.0033] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECT The goal of this study was to examine the potential use of ophthalmodynamometry in the noninvasive assessment of intracranial pressure (ICP). Under normal conditions, pressure within the central retinal vein is equal to or greater than ICP, because the central retinal vein basses through the optic nerve before it drains into the cavernous sinus. The optic nerve sheath is the place where ICP affects retinal venous pressure. Suction ophthalmodynamometry is an established method of investigation in ophthalmology to determine the pressure of the central retinal artery. Although observations of papilledema and lack of venous pulsations are commonly used to provide a vague assessment of ICP, ophthalmodynamometry may be used to determine the pressure of the central retinal vein. This venous pressure has never been compared with ICP. METHODS In this study the pressure of the central retinal vein was recorded in 22 patients who underwent continuous simultaneous registration of ICP for various reasons, mainly for suspected hydrocephalus. A comparison of the two pressures was made. The results indicated a highly significant linear correlation between central retinal vein pressure and ICP. These results are of great practical value because up-to-date reliable ICP monitoring has only been possible by using invasive means, by placing a probe extradurally or subdurally into the brain parenchyma or a ventricle. CONCLUSIONS Ophthalmodynamometry can be relevant for momentary assessment and is not suitable for continuous monitoring. However, this technique can easily be repeated and may be used whenever increased ICP is suspected in a patient suffering from hydrocephalus, brain tumors, or head injury.
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Affiliation(s)
- R Firsching
- Klinik für Neurochirurgie und Universitätsaugenklinik, Otto-von-Guericke-Universität Magdeburg, Germany
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Abstract
We show that although there is a significant correlation between intraocular pressure and intracranial pressure in neurosurgical patients, changes in intraocular pressure are a poor predictor of changes in intracranial pressure.
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Firsching R, Schütze M, Motschmann M, Behrens-Baumann W, Meyer-Schwickerath R. Non-invasive measurement of intracranial pressure. Lancet 1998; 351:523-4. [PMID: 9482475 DOI: 10.1016/s0140-6736(05)78717-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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