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Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension

Purpose  Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively ass...

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Autores principales: Schmidt, Bernhard, Czosnyka, Marek, Cardim, Danilo, Czosnyka, Zofia, Rosengarten, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10063336/
https://www.ncbi.nlm.nih.gov/pubmed/34496407
http://dx.doi.org/10.1055/a-1586-6487
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author Schmidt, Bernhard
Czosnyka, Marek
Cardim, Danilo
Czosnyka, Zofia
Rosengarten, Bernhard
author_facet Schmidt, Bernhard
Czosnyka, Marek
Cardim, Danilo
Czosnyka, Zofia
Rosengarten, Bernhard
author_sort Schmidt, Bernhard
collection PubMed
description Purpose  Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH. Materials and Methods  nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH (2) O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed. Results  In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH (2) O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH (2) O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH (2) O with both a sensitivity and specificity of 0.92. Presuming 20 cmH (2) O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases. Conclusion  The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected.
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spelling pubmed-100633362023-03-31 Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension Schmidt, Bernhard Czosnyka, Marek Cardim, Danilo Czosnyka, Zofia Rosengarten, Bernhard Ultraschall Med Purpose  Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH. Materials and Methods  nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH (2) O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed. Results  In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH (2) O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH (2) O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH (2) O with both a sensitivity and specificity of 0.92. Presuming 20 cmH (2) O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases. Conclusion  The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected. Georg Thieme Verlag KG 2021-09-08 /pmc/articles/PMC10063336/ /pubmed/34496407 http://dx.doi.org/10.1055/a-1586-6487 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Schmidt, Bernhard
Czosnyka, Marek
Cardim, Danilo
Czosnyka, Zofia
Rosengarten, Bernhard
Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title_full Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title_fullStr Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title_full_unstemmed Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title_short Is Lumbar Puncture Needed? – Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension
title_sort is lumbar puncture needed? – noninvasive assessment of icp facilitates decision making in patients with suspected idiopathic intracranial hypertension
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10063336/
https://www.ncbi.nlm.nih.gov/pubmed/34496407
http://dx.doi.org/10.1055/a-1586-6487
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