Advertisement

Optic nerve ultrasonography in monitoring treatment efficacy in pediatric idiopathic intracranial hypertension

Abstract

Purpose

Measurement of optic nerve sheath diameter (ONSD) with ocular ultrasonography (USG) is a noninvasive technique that can be readily used to determine clues of increased intracranial pressure. In this study, we aimed to determine the role of optic nerve sheath diameter measurements in the diagnosis and follow-up of pediatric patients with idiopathic intracranial hypertension (IIH).

Methods

Eight patients with a diagnosis of IIH with a median age of 11.7 (range 4.5–17) years were examined prospectively. During follow-up, orbital ultrasonography (USG) was performed immediately prior to lumbar puncture (LP) and at 24 h, at 1 week, and between 1 and 18 months after LP. Cranial MRI examinations and automated visual field assessments were performed at baseline and at 3 months, and both measurements were compared with each other.

Results

The mean cerebrospinal fluid opening pressure (37.75 ± 12.64 cm H2O) and the mean ONSD (5.94 ± 0.46 mm) were correlated. The median follow-up was 16 (range, 12–18 months), and ONSD regressed gradually consistent with clinical and radiologic improvement during follow-up.

Conclusions

To the best of our knowledge, this is the first prospective pilot study performed on pediatric patients with IIH using orbital USG for ONSD measurements. Despite the small sample size, the present study indicated that orbital USG may be used as a promising noninvasive tool to diagnose increased intracranial pressure and for monitoring treatment efficacy in this special patient population.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165

  2. 2.

    Sheldon CA, Paley GL, Beres SJ, McCormack SE, Liu GT (2017) Pediatric pseudotumor cerebri syndrome: diagnosis, classification, and underlying pathophysiology. Semin Pediatr Neurol 24:110–115

  3. 3.

    Ko MW, Liu GT (2010) Pediatric idiopathic intracranial hypertension (pseudotumor cerebri). Horm Res Paediatr 74:381–389

  4. 4.

    Phillips PH, Sheldon CA (2017) Pediatric pseudotumor cerebri syndrome. J Neuroophthalmol 37:33–40

  5. 5.

    Borire AA, Hughes AR, Lueck CJ (2015) Tonsillar herniation after lumbar puncture in idiopathic intracranial hypertension. J Neuroophthalmol 35:293–295

  6. 6.

    Avery RA, Shah SS, Licht DJ, Seiden JA, Huh JW, Boswinkel J, Ruppe MD, Chew A, Mistry RD, Liu GT (2010) Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 363:891–893

  7. 7.

    Chacko J (2014) Optic nerve sheath diameter: an ultrasonographic window to view raised intracranial pressure? Indian J Crit Care Med 18:707–708

  8. 8.

    Irazuzta JE, Brown ME, Akhtar J (2016) Bedside optic nerve sheath diameter assessment in the identification of increased intracranial pressure in suspected idiopathic intracranial hypertension. Pediatr Neurol 54:35–38

  9. 9.

    Lee YA, Tomsak RL, Sadikovic Z, Bahl R, Sivaswamy L (2016) Use of ocular coherence tomography in children with idiopathic intracranial hypertension-a single-center experience. Pediatr Neurol 58:101–106

  10. 10.

    Hirfanoglu T, Aydin K, Serdaroglu A, Havali C (2015) Novel magnetic resonance imaging findings in children with intracranial hypertension. Pediatr Neurol 53:151–156

  11. 11.

    McCafferty B, McClelland CM, Lee MS (2017) The diagnostic challenge of evaluating papilledema in the pediatric patient. Taiwan J Ophthalmol 7:15–21

  12. 12.

    Koziarz A, Sne N, Kegel F, Alhazzani W, Nath S, Badhiwala JH, Rice T, Engels P, Samir F, Healey A, Kahnamoui K, Banfield L, Sharma S, Reddy K, Hawryluk GWJ, Kirkpatrick AW, Almenawer SA (2017) Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol. BMJ Open 7:e016194

  13. 13.

    Körber F, Scharf M, Moritz J, Dralle D, Alzen G (2005) Sonography of the optical nerve: experience in 483 children. Rofo 177:229–235

  14. 14.

    Lochner P, Nardone R, Tezzon F, Coppo L, Brigo F (2013) Optic nerve sonography to monitor treatment efficacy in idiopathic intracranial hypertension: a case report. J Neuroimaging 23:533–534

  15. 15.

    Bassan H, Berkner L, Stolovitch C, Kesler A (2008) Asymptomatic idiopathic intracranial hypertension in children. Acta Neurol Scand 118:251–255

  16. 16.

    Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59:1492–1495

  17. 17.

    Gospe SM 3rd, Bhatti MT, El-Dairi MA (2016) Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. Br J Ophthalmol 100:505–509

  18. 18.

    Kimberly HH, Shah S, Marill K, Noble V (2008) Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 15:201–204

  19. 19.

    Hassen GW, Nazeer O, Manizate F (2014) The role of bedside ultrasound in pretherapeutic and posttherapeutic lumbar puncture in patient with idiopathic intracranial hypertension. Am J Emerg Med 32(1298):e3–e4

  20. 20.

    Caffery TS, Perret JN, Musso MW, Jones GN (2014) Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure. Am J Emerg Med 32:1513–1515

  21. 21.

    Major R, Girling S, Boyle A (2011) Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J 28:679–681

  22. 22.

    Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, Dutton GN (1999) Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 54:740–742

  23. 23.

    Irazuzta JE, Brown ME, Akhtar J (2016) Bedside optic nerve sheath diameter assessment in the identification of increased intracranial pressure in suspected idiopathic intracranial hypertension. Pediatr Neurol 54:35–38

  24. 24.

    Shuper A, Snir M, Barash D, Yassur Y, Mimouni M (1997) Ultrasonography of the optic nerves: clinical application in children with pseudotumor cerebri. J Pediatr 131:734–740

  25. 25.

    Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol 26:706–710

  26. 26.

    Inger HE, Rogers DL, McGregor ML, Aylward SC, Reem RE (2017) Diagnostic criteria in pediatric intracranial hypertension. J AAPOS 21:492-5. e2

  27. 27.

    Lublinsky S, Kesler A, Friedman A, Horev A, Shelef I (2018) Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging. J Magn Reson Imaging 47:913–927

  28. 28.

    Chang RO, Marshall BK, Yahyavi N, Sharma A, Huecker J, Gordon MO, McClelland C, Van Stavern GP (2016) Neuroimaging features of idiopathic intracranial hypertension persist after resolution of papilloedema. Neuroophthalmology 40:165–170

Download references

Author information

Correspondence to Leman Tekin Orgun.

Ethics declarations

Conflict of interest

The authors report no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tekin Orgun, L., Atalay, H.T., Arhan, E. et al. Optic nerve ultrasonography in monitoring treatment efficacy in pediatric idiopathic intracranial hypertension. Childs Nerv Syst (2020). https://doi.org/10.1007/s00381-019-04497-2

Download citation

Keywords

  • Idiopathic intracranial hypertension
  • Intracranial pressure
  • Headache
  • Ocular ultrasonography
  • Orbital ultrasonography
  • Optic nerve sheath diameter