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The efficacy of orbital ultrasonography and magnetic resonance imaging findings with direct measurement of intracranial pressure in distinguishing papilledema from pseudopapilledema

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Abstract

Introduction

The goal of this study was to evaluate the utility of orbital ultrasonography and magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension (IIH).

Method

We reviewed the medical records of patients referred to our department for suspected IIH.

Results

Seven children were diagnosed with IIH. Nine children revealed pseudopapilledema by optic coherence tomography and/or orbital ultrasonography. When the axial sequences were reexamined, patients with papilledema had optic nerve sheath (ONS) enlargement (6.62 ± 0.70 mm); patients with pseudopapilledema had ONS diameter as 4.62 ± 0.64 mm. There was a significant correlation between the CSF opening pressure and ONS diameter (p < 0.005, r = 0.661). In the papilledema group, the presence of proposed subtle markers as increased tortuosity in the optic nerve was found in six patients. Five of seven patients had a target sign, intraocular protrusion of the optic nerve, and posterior globe flattening.

Discussion

Ophthalmological review is important to avoid unnecessary procedures for detection of true papilledema. ONS diameter is a reliable neuroimaging marker as other subtle markers.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Pediatric Neurology, Gazi University, 06510, Ankara, Besevler, Turkey

    Zeynep Ozturk, Ebru Arhan, Kursad Aydin, Ayse Serdaroglu, Tugba Hirfanoglu & Yilmaz Akbas

  2. Faculty of Medicine, Department of Ophthalmology, Gazi University, Ankara, Turkey

    Tuba Atalay & Duygu Yalinbas

  3. Department of Pediatric Neurology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey

    Cengiz Havali

Authors
  1. Zeynep Ozturk
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  2. Tuba Atalay
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  3. Ebru Arhan
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  4. Kursad Aydin
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  5. Ayse Serdaroglu
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  6. Tugba Hirfanoglu
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  7. Cengiz Havali
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Corresponding author

Correspondence to Zeynep Ozturk.

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The institutional board of Gazi University approved the study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Ozturk, Z., Atalay, T., Arhan, E. et al. The efficacy of orbital ultrasonography and magnetic resonance imaging findings with direct measurement of intracranial pressure in distinguishing papilledema from pseudopapilledema. Childs Nerv Syst 33, 1501–1507 (2017). https://doi.org/10.1007/s00381-017-3454-6

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  • DOI: https://doi.org/10.1007/s00381-017-3454-6

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