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Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema.
World Neurosurg. 2018 Mar; 111:e221-e227.WN

Abstract

BACKGROUND

Idiopathic intracranial hypertension (IIH) is characterized by headaches, visual obscurations, and papilledema, and the diagnosis involves lumbar puncture (LP) with an elevated opening pressure (OP) ≥20 cm H20. When papilledema is absent, the diagnosis becomes less clear. Some physicians have argued that the absence of papilledema rules out IIH, whereas others maintain that elevated OP is sufficient for diagnosis.

METHODS

The authors performed a single-institution 4-year retrospective analysis of patients who underwent invasive intracranial pressure (ICP) monitoring for presumed IIH.

RESULTS

A total of 22 patients were reviewed, and 13 had classic symptoms of IIH, documented elevated OP, and absence of papilledema; 5/13 (38%) patients had proven intracranial hypertension as shown by invasive ICP monitoring, whereas 8/13 (62%) had normal ICP.

CONCLUSIONS

With the use of current diagnostic algorithms of clinical presentation and elevated OP, over half of patients without papilledema in our series would be falsely diagnosed with IIH, which could result in unnecessary medical and surgical intervention. Thus, elevated OP as determined by LP is insufficient to diagnose IIH. On the other hand, the absence of papilledema does not rule out intracranial hypertension.

Authors+Show Affiliations

Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA. Electronic address: raslana@ohsu.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29258930

Citation

Bridges, Kelly J., and Ahmed M. Raslan. "Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema." World Neurosurgery, vol. 111, 2018, pp. e221-e227.
Bridges KJ, Raslan AM. Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema. World Neurosurg. 2018;111:e221-e227.
Bridges, K. J., & Raslan, A. M. (2018). Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema. World Neurosurgery, 111, e221-e227. https://doi.org/10.1016/j.wneu.2017.12.036
Bridges KJ, Raslan AM. Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema. World Neurosurg. 2018;111:e221-e227. PubMed PMID: 29258930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema. AU - Bridges,Kelly J, AU - Raslan,Ahmed M, Y1 - 2017/12/16/ PY - 2017/10/05/received PY - 2017/12/06/revised PY - 2017/12/08/accepted PY - 2017/12/21/pubmed PY - 2018/5/15/medline PY - 2017/12/21/entrez KW - Idiopathic intracranial hypertension KW - Intracranial pressure KW - Lumbar puncture KW - Opening pressure KW - Papilledema SP - e221 EP - e227 JF - World neurosurgery JO - World Neurosurg VL - 111 N2 - BACKGROUND: Idiopathic intracranial hypertension (IIH) is characterized by headaches, visual obscurations, and papilledema, and the diagnosis involves lumbar puncture (LP) with an elevated opening pressure (OP) ≥20 cm H20. When papilledema is absent, the diagnosis becomes less clear. Some physicians have argued that the absence of papilledema rules out IIH, whereas others maintain that elevated OP is sufficient for diagnosis. METHODS: The authors performed a single-institution 4-year retrospective analysis of patients who underwent invasive intracranial pressure (ICP) monitoring for presumed IIH. RESULTS: A total of 22 patients were reviewed, and 13 had classic symptoms of IIH, documented elevated OP, and absence of papilledema; 5/13 (38%) patients had proven intracranial hypertension as shown by invasive ICP monitoring, whereas 8/13 (62%) had normal ICP. CONCLUSIONS: With the use of current diagnostic algorithms of clinical presentation and elevated OP, over half of patients without papilledema in our series would be falsely diagnosed with IIH, which could result in unnecessary medical and surgical intervention. Thus, elevated OP as determined by LP is insufficient to diagnose IIH. On the other hand, the absence of papilledema does not rule out intracranial hypertension. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29258930/Utility_of_Intracranial_Pressure_Monitoring_for_Diagnosis_of_Idiopathic_Intracranial_Hypertension_in_the_Absence_of_Papilledema_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)32152-6 DB - PRIME DP - Unbound Medicine ER -