Is Lumbar Puncture Needed? - Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension.

Abstract

PURPOSE:

 Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH.

MATERIALS AND METHODS:

 nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH2O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed.

RESULTS:

 In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH2O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH2O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH2O with both a sensitivity and specificity of 0.92. Presuming 20 cmH2O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases.

CONCLUSION:

 The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected.

• Authors: Bernhard Schmidt, Marek Czosnyka, Danilo Cardim, Zofia Czosnyka, Bernhard Rosengarten
• Journal: Ultraschall in der Medizin (Stuttgart, Germany : 1980) (Ultraschall Med) Vol. 44 Issue 2 Pg. e91-e98 (Apr 2023) ISSN: 1438-8782 [Electronic] Germany
• Vernacular Title: Lumbalpunktion notwendig? – Die nichtinvasive Erfassung des intrakraniellen Drucks ermöglicht die Entscheidungsfindung bei Patienten mit Verdacht auf idiopathische intrakranielle Hypertension.
• PMID: 34496407 (Publication Type: Journal Article)
• Copyright: The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Topics

• Humans
• Female
• Young Adult
• Adult
• Pseudotumor Cerebri (diagnostic imaging)
• Spinal Puncture
• Ultrasonography, Doppler, Transcranial (methods)
• Intracranial Pressure (physiology)
• Decision Making
• Intracranial Hypertension (diagnostic imaging)