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Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator

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:...

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Autores principales: Fichtner, Jens, Ulrich, Christian T, Fung, Christian, Knüppel, Christin, Veitweber, Martina, Jilch, Astrid, Schucht, Philippe, Ertl, Michael, Schömig, Beate, Gralla, Jan, Z'Graggen, Werner J, Bernasconi, Corrado, Mattle, Heinrich P, Schlachetzki, Felix, Raabe, Andreas, Beck, Jürgen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893146/
https://www.ncbi.nlm.nih.gov/pubmed/26285586
http://dx.doi.org/10.1136/jnnp-2015-310853
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author Fichtner, Jens
Ulrich, Christian T
Fung, Christian
Knüppel, Christin
Veitweber, Martina
Jilch, Astrid
Schucht, Philippe
Ertl, Michael
Schömig, Beate
Gralla, Jan
Z'Graggen, Werner J
Bernasconi, Corrado
Mattle, Heinrich P
Schlachetzki, Felix
Raabe, Andreas
Beck, Jürgen
author_facet Fichtner, Jens
Ulrich, Christian T
Fung, Christian
Knüppel, Christin
Veitweber, Martina
Jilch, Astrid
Schucht, Philippe
Ertl, Michael
Schömig, Beate
Gralla, Jan
Z'Graggen, Werner J
Bernasconi, Corrado
Mattle, Heinrich P
Schlachetzki, Felix
Raabe, Andreas
Beck, Jürgen
author_sort Fichtner, Jens
collection PubMed
description 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.
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spelling pubmed-48931462016-06-09 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 J Bernasconi, Corrado Mattle, Heinrich P Schlachetzki, Felix Raabe, Andreas Beck, Jürgen J Neurol Neurosurg Psychiatry General Neurology 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. BMJ Publishing Group 2016-06 2015-08-18 /pmc/articles/PMC4893146/ /pubmed/26285586 http://dx.doi.org/10.1136/jnnp-2015-310853 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle General Neurology
Fichtner, Jens
Ulrich, Christian T
Fung, Christian
Knüppel, Christin
Veitweber, Martina
Jilch, Astrid
Schucht, Philippe
Ertl, Michael
Schömig, Beate
Gralla, Jan
Z'Graggen, Werner J
Bernasconi, Corrado
Mattle, Heinrich P
Schlachetzki, Felix
Raabe, Andreas
Beck, Jürgen
Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title_full Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title_fullStr Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title_full_unstemmed Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title_short Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
title_sort management of spontaneous intracranial hypotension – transorbital ultrasound as discriminator
topic General Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893146/
https://www.ncbi.nlm.nih.gov/pubmed/26285586
http://dx.doi.org/10.1136/jnnp-2015-310853
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