Sonographic and ophthalmic assessment of optic nerve in patients with idiopathic intracranial hypertension: A longitudinal study

To assess the validity of neurosonological parameters (transorbital sonography (TOS)) for detection and monitoring of patients with idiopathic intracranial hypertension (IIH). Prospective, single-center, case-controlled study in 25 patients with IIH and 19 controls. Visual parameters of papilledema,...

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Bibliographic Details
Published in:	Journal of the neurological sciences Vol. 430; p. 118069
Main Authors:	Knodel, S., Roemer, S.N., Moslemani, K., Wykrota, A., Käsmann-Kellner, B., Seitz, B., Wagenpfeil, G., Fassbender, K., Naldi, A., Kalampokini, S., Lochner, P.
Format:	Journal Article
Language:	English
Published:	Elsevier B.V 15-11-2021
Subjects:	Idiopathic intracranial hypertension Neuro ophthalmological parameters Optic nerve sheath diameter Papilledema Pseudotumor cerebri syndrome Transorbital sonography Transorbital sonography Papilledema Neuro ophthalmological parameters Pseudotumor cerebri syndrome Idiopathic intracranial hypertension Optic nerve sheath diameter
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Summary:	To assess the validity of neurosonological parameters (transorbital sonography (TOS)) for detection and monitoring of patients with idiopathic intracranial hypertension (IIH). Prospective, single-center, case-controlled study in 25 patients with IIH and 19 controls. Visual parameters of papilledema, visual acuity, computerized static threshold perimetry, fundus examination, and neurosonological parameters of papilledema/optic disc elevation (ODE), optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) were recorded at baseline and only for patients with IIH again within 6 months. ONSD was significantly enlarged among individuals with IIH (6.2 ± 0.73 mm) compared to controls (4.99 ± 0.54 mm; p < 0.001). Bilateral ODE was found in 36/50 eyes in patients at their initial visit and in none of the controls. Re-evaluation 6 months later showed a significant reduction of ONSD (6.0 ± 0.7 mm; p = 0.024) and ODE (0.2 (0–1) mm; p ≤0.001). Best corrected visual acuity (BCVA) and square root of lost variance (sLV) remained stable. Headache intensity (Numeric rating scale, NRS) improved significantly p < 0.001. When compared to patients with first diagnosed IIH (n = 18), the subset of patients with preexisting IIH with acute relapse (n = 7) showed persistent but reduced levels of ICP increase. They also presented significant decrease of BVCA (p = 0.01) and mean defect (MD) (p = 0.012). Re-evaluation 6 months later showed significant change in ODE in both groups. Our study confirmed that TOS and ophthalmological parameters are a valuable and non-invasive method to detect and monitor elevated ICP in IIH. •Most patients with IIH displayed enlarged ONSD and papilledema.•The best cut-off value for predicting elevated ICP in IIH was 5.8 mm.•Sonographic and ophthalmological tools are reliable in the diagnosis and follow-up of IIH.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-510X 1878-5883
DOI:	10.1016/j.jns.2021.118069