Skip to main content
SpringerLink
Log in

Ocular ultrasound for monitoring pseudotumor cerebri syndrome

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the feasibility of ocular ultrasound in the follow-up of pseudotumor cerebri syndrome and to correlate ultrasound with clinical parameters. In a cohort study of 22 consecutive adult patients, ocular ultrasound was performed measuring optic nerve sheath diameter, optic nerve diameter, and optic disc elevation compared with symptoms referred by the patients. The patients showed increased optic nerve sheath diameter [median, 6.51 mm (interquartile range 6.13–7.10)], optic nerve diameter [3.02 mm (2.86–3.27)], and optic disc elevation [0.90 mm (0.64–1.36)] at the time of admission and had ophthalmologically confirmed the presence of papilledema in all 22 patients. After 6 months all parameters decreased significantly for optic nerve sheath diameter [6.08 mm (5.59–6.73), P = 0.002], optic nerve diameter [2.87 mm (2.70–3.15), P = 0.007], and optic disc elevation [0.48 mm (0.30–0.70), P < 0.001]. In addition, a discrete negative correlation between optic nerve sheath diameter and headache change after 6 months was observed with ρ = − 0.477 and P = 0.02. No correlation was found between optic disc elevation and headache. In conclusion, longitudinal follow-up with ocular ultrasound combined with clinical information may provide support for treatment of this condition.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Friedmann DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165. https://doi.org/10.1212/WNL.0b013e3182a55f17

    Article  Google Scholar 

  2. Kesler A, Mosek A, Fithlicher N, Gidron Y (2005) Psychological correlates of idiopathic intracranial hypertension. Isr Med Assoc J 7:627–630

    PubMed  Google Scholar 

  3. Whiteley W, Al-Shahi R, Warlow CP, Zeidler M, Lueck CJ (2006) CSF opening pressure: reference interval and the effect of body mass index. Neurology 67:1690–1691

    Article  CAS  PubMed  Google Scholar 

  4. Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J (2008) Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 34:2062–2067. https://doi.org/10.1007/s00134-008-1149-x

    Article  PubMed  Google Scholar 

  5. Bäuerle J, Nedelmann M (2011) Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 258:2014–2019. https://doi.org/10.1007/s00415-011-6059-0

    Article  PubMed  Google Scholar 

  6. Lochner P, Brigo F, Zedde ML, Sanguigni S, Coppo L, Nardone R, Naldi A, Sola D, Stolz E (2016) Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension. BMC Neurol 16:85. https://doi.org/10.1186/s12883-016-0594-3

    Article  PubMed  PubMed Central  Google Scholar 

  7. del Saz-Saucedo P, Redondo-González O, Mateu-Mateu Á, Huertas-Arroyo R, García-Ruiz R, Botia-Paniagua E (2016) Sonographic assessment of the optic nerve sheath diameter in the diagnosis of idiopathic intracranial hypertension. J Neurol Sci 361:122–127. https://doi.org/10.1016/j.jns.2015.12.032

    Article  PubMed  Google Scholar 

  8. Rehman H, Khan MS, Nafees M, Rehman AU, Habib A (2016) Optic nerve sheath diameter on sonography in idiopathic intracranial hypertension versus normal. J Coll Physicians Surg Pak 26:758–760

    PubMed  Google Scholar 

  9. Singleton J, Dagan A, Edlow JA, Hoffmann B (2015) Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension. Am J Emerg Med 33(860):e5–e7. https://doi.org/10.1016/j.ajem.2014.12.030

    Google Scholar 

  10. 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. https://doi.org/10.1111/jon.12005

    Article  PubMed  Google Scholar 

  11. Sinclair AJ, Burdon MA, Nightingale PG, Ball AK, Good P, Matthews TD, Jacks A, Lawden M, Clarke CE, Stewart PM, Walker EA, Tomlinson JW, Rauz S (2010) Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ 341:c2701. https://doi.org/10.1136/bmj.c2701

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aicher B, Peil H, Peil B, Diener HC (2012) Pain measurement: Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) in clinical trials with OTC analgesics in headache. Cephalalgia 32:185–197. https://doi.org/10.1177/0333102411430856

    Article  CAS  PubMed  Google Scholar 

  13. Lochner P, Coppo L, Cantello R, Nardone R, Naldi A, Leone MA, Brigo F (2016) Intra- and interobserver reliability of transorbital sonographic assessment of the optic nerve sheath diameter and optic nerve diameter in healthy adults. J Ultrasound 19:41–45. https://doi.org/10.1007/s40477-014-0144-z

    Article  PubMed  Google Scholar 

  14. Teismann N, Lenaghan P, Nolan R, Stein J, Green A (2013) Point-of-care ocular ultrasound to detect optic disc swelling. Acad Emerg Med 20:920–925. https://doi.org/10.1111/acem.12206

    Article  PubMed  Google Scholar 

  15. Bäuerle J, Lochner P, Kaps M, Nedelmann M (2012) Intra- and interobsever reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging 22:42–45. https://doi.org/10.1111/j.1552-6569.2010.00546.x

    Article  PubMed  Google Scholar 

  16. Gücer G, Viernstein L (1978) Long-term intracranial pressure recording in the management of pseudotumor cerebri. J Neurosurg 49:256–263

    Article  PubMed  Google Scholar 

  17. Shah VA, Kardon RH, Lee AG, Corbett JJ, Wall M (2008) Long-term follow-up of idiopathic intracranial hypertension: the Iowa experience. Neurology 70:634–640. https://doi.org/10.1212/01.wnl.0000299893.43918.a8

    Article  CAS  PubMed  Google Scholar 

  18. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D (1982) Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 39:461–474

    Article  CAS  PubMed  Google Scholar 

  19. Killer HE, Jaggi GP, Flammer J, Miller NR, Huber AR, Mironov A (2007) Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain 130:514–520

    Article  CAS  PubMed  Google Scholar 

  20. Chiang J, Wong E, Whatham A, Hennessy M, Kalloniatis M, Zangerl B (2015) The usefulness of multimodal imaging for differentiating pseudopapilloedema and true swelling of the optic nerve head: a review and case series. Clin Exp Optom 98:12–24. https://doi.org/10.1111/cxo.12177

    Article  PubMed  Google Scholar 

  21. Sinclair AJ, Burdon MA, Nightingale PG, Matthews TD, Jacks A, Lawden M, Sivaguru A, Gaskin BJ, Rauz S, Clarke CE, Ball AK (2012) Rating papilloedema: an evaluation of the Frisén classification in idiopathic intracranial hypertension. J Neurol 259:1406–1412. https://doi.org/10.1007/s00415-011-6365-6

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Francesco Brigo and Erwin Stolz contributed equally as senior authors.

Authors and Affiliations

  1. Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany

    Piergiorgio Lochner, Klaus Fassbender & Martin Lesmeister

  2. Division of Neurology, “Franz Tappeiner” Hospital, Merano, BZ, Italy

    Piergiorgio Lochner, Raffaele Nardone, Andrea Orioli & Francesco Brigo

  3. Department of Neurology, and Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Salzburg, Austria

    Raffaele Nardone

  4. Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

    Francesco Brigo

  5. Department of Neurology, Justus-Liebig University, Giessen, Germany

    Erwin Stolz

Authors
  1. Piergiorgio Lochner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Fassbender
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Lesmeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele Nardone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Orioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Brigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erwin Stolz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piergiorgio Lochner.

Ethics declarations

Funding

The study received no sponsorship or funding.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lochner, P., Fassbender, K., Lesmeister, M. et al. Ocular ultrasound for monitoring pseudotumor cerebri syndrome. J Neurol 265, 356–361 (2018). https://doi.org/10.1007/s00415-017-8699-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-017-8699-1

Keywords

Search

Navigation