Fichtner, Jens and Ulrich, Christian T. and Fung, Christian and Knueppel, Christin and Veitweber, Martina and Jilch, Astrid and Schucht, Philippe and Ertl, Michael and Schoemig, Beate and Gralla, Jan and Z'Graggen, Werner J. and Bernasconi, Corrado and Mattle, Heinrich P. and Schlachetzki, Felix and Raabe, Andreas and Beck, Juergen (2016) Management of spontaneous intracranial hypotension - Transorbital ultrasound as discriminator. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 87 (6). pp. 650-655. ISSN 0022-3050, 1468-330X
Full text not available from this repository. (Request a copy)Abstract
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: | Article |
|---|---|
| Uncontrolled Keywords: | OPTIC-NERVE SHEATH; PUNCTURE HEADACHE; BLOOD PATCH; PRESSURE; DIAMETER; HYPERTENSION; SONOGRAPHY; DIAGNOSIS; PATIENT; LEAKS; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 25 Mar 2019 13:51 |
| Last Modified: | 25 Mar 2019 13:51 |
| URI: | https://pred.uni-regensburg.de/id/eprint/2891 |
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