scholarly journals Relationship between the optic nerve sheath diameter and lumbar cerebrospinal fluid pressure in patients with normal tension glaucoma

Eye ◽  
2017 ◽  
Vol 31 (9) ◽  
pp. 1365-1372 ◽  
Author(s):  
A Pircher ◽  
M Montali ◽  
J Berberat ◽  
L Remonda ◽  
H E Killer
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Fluid Pressure ◽  
Normal Tension Glaucoma ◽  
Optic Nerve Sheath Diameter ◽  
Cerebrospinal Fluid Pressure ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Lumbar Cerebrospinal Fluid

Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Jens Fichtner ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Debora Cipriani ◽  
Jan Gralla ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Sheath ◽  
Fluid Leak

Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (−0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.

Optic nerve sheath diameter in normal-tension glaucoma patients

2011 ◽  
Vol 96 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Gregor Peter Jaggi ◽  
Neil Richard Miller ◽  
Josef Flammer ◽  
Robert N Weinreb ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Normal Tension Glaucoma ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath

scholarly journals Lower body negative pressure reduces optic nerve sheath diameter during head-down tilt

2017 ◽  
Vol 123 (5) ◽  
pp. 1139-1144 ◽  
Author(s):  
Karina Marshall-Goebel ◽  
Robert Terlević ◽  
Darius A. Gerlach ◽  
Simone Kuehn ◽  
Edwin Mulder ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Negative Pressure ◽  
Lower Body Negative Pressure ◽  
Ambient Air ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Fluid Distribution ◽  
Lower Body ◽  
Nerve Sheath

The microgravity ocular syndrome (MOS) results in significant structural and functional ophthalmic changes during 6-mo spaceflight missions consistent with an increase in cerebrospinal fluid (CSF) pressure compared with the preflight upright position. A ground-based study was performed to assess two of the major hypothesized contributors to MOS, headward fluid shifting and increased ambient CO2, on intracranial and periorbital CSF. In addition, lower body negative pressure (LBNP) was assessed as a countermeasure to headward fluid shifting. Nine healthy male subjects participated in a crossover design study with five head-down tilt (HDT) conditions: −6, −12, and −18° HDT, −12° HDT with −20 mmHg LBNP, and −12° HDT with a 1% CO2 environment, each for 5 h total. A three-dimensional volumetric scan of the cranium and transverse slices of the orbita were collected with MRI, and intracranial CSF volume and optic nerve sheath diameter (ONSD) were measured after 4.5 h HDT. ONSD increased during −6° ( P < 0.001), −12° ( P < 0.001), and −18° HDT ( P < 0.001) and intracranial CSF increased during −12° HDT ( P = 0.01) compared with supine baseline. Notably, LBNP was able to reduce the increases in ONSD and intracranial CSF during HDT. The addition of 1% CO2 during HDT, however, had no further effect on ONSD, but rather ONSD increased from baseline in a similar magnitude to −12° HDT with ambient air ( P = 0.001). These findings demonstrate the ability of LBNP, a technique that targets fluid distribution in the lower limbs, to directly influence CSF and may be a promising countermeasure to help reduce increases in CSF. NEW & NOTEWORTHY This is the first study to demonstrate the ability of lower body negative pressure to directly influence cerebrospinal fluid surrounding the optic nerve, indicating potential use as a countermeasure for increased cerebrospinal fluid on Earth or in space.

scholarly journals Lipocalin-type Prostaglandin D Synthase Concentration Gradients in the Cerebrospinal Fluid in Normal-tension Glaucoma Patients with Optic Nerve Sheath Compartmentation

Eye and Brain ◽  
2021 ◽  
Vol Volume 13 ◽  
pp. 89-97
Author(s):  
Achmed Pircher ◽  
Albert Neutzner ◽  
Margherita Montali ◽  
Andreas Huber ◽  
Hendrik PN Scholl ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Normal Tension Glaucoma ◽  
Optic Nerve Sheath ◽  
Concentration Gradients ◽  
Nerve Sheath ◽  
Prostaglandin D Synthase

scholarly journals Ultrasonic measurement of optic nerve sheath diameter: a non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure

2018 ◽  
Vol 103 (4) ◽  
pp. 437-441 ◽  
Author(s):  
Li-min Chen ◽  
Li-juan Wang ◽  
Yang Hu ◽  
Xiao-han Jiang ◽  
Yu-zhi Wang ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Real Time ◽  
Vertical Section ◽  
Fluid Pressure ◽  
Correlation Coefficients ◽  
Optic Nerve Sheath Diameter ◽  
Ultrasonic Measurement ◽  
Optic Nerve Sheath ◽  
Nerve Sheath

The current study aimed to identify whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) could dynamically and sensitively evaluate real-time intracranial pressure (ICP). ONSD measurements were performed approximately 5  min prior to and after a lumbar puncture (LP). A total of 84 patients (mean±SD age, 43.5±14.7 years; 41 (49%) men; 18 patients with elevated ICP) were included in the study. The Spearman correlation coefficients between the two observers were 0.779 and 0.703 in the transverse section and 0.751 and 0.788 in the vertical section for the left and right eyes, respectively. The median (IQR) change in ONSD (ΔONSD) and change in ICP (ΔICP) were 0.11 (0.05–0.21) mm and 30 (20–40) mmH2O, respectively, for all participants. With a reduction in cerebrospinal fluid pressure, 80 subjects (95%) showed an immediate drop in ONSD; the median (IQR) decreased from 4.13 (4.02–4.38) mm to 4.02 (3.90–4.23) mm (p<0.001). Significant correlations were found between ONSD and ICP before LPs (r=0.482, p<0.01) and between ΔONSD and ΔICP (r=0.451, p<0.01). Ultrasonic measurement of ONSD can reflect the relative real-time changes in ICP.

Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests

1997 ◽  
Vol 87 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Hans-Christian Hansen ◽  
Knut Helmke
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Fluid Pressure ◽  
Optic Nerve Sheath ◽  
Variable Pressure ◽  
Content Type ◽  
Csf Pressure ◽  
Nerve Sheath ◽  
Intrathecal Infusion ◽  
Fine Print

✓ Raised intracranial pressure leads to increased pressure around the optic nerve (ON), which underlies the formation of papilledema and the enlargement of the dural optic nerve sheath (ONS). In clinical practice, the presence of widened ONSs is demonstrable on neuroimaging, but their relationship to cerebrospinal fluid (CSF) pressure remains unknown. The authors investigated the ONS response to pressure during CSF absorption studies in 12 patients undergoing neurological testing. The ONS diameter was evaluated by serial B-mode ultrasound scans of the anterior ON near its entry into the globe. All patients tested showed ONS diameter changes that exhibited covariance with the alteration of lumbar CSF pressure and were completely reversible during the infusion tests. The maximum difference in ONS diameter between baseline and peak pressure conditions was 1.8 mm on average (range 0.7–3.1 mm), corresponding to an average ONS diameter variation of 45% (range 15–89%). Regression analysis yielded a linear covariance between ONS diameter and CSF pressure with different slopes across subjects (0.019–0.071 mm/mm Hg, mean r = 0.78). However, this linear relationship was only present within a CSF pressure interval. This interval differed between patients: ONS dilation commenced at pressure thresholds between 15 mm Hg and 30 mm Hg and in some patients saturation of the response (constant ONS diameter) occurred between 30 mm Hg and 40 mm Hg. With a single exception, definitely enlarged ONS diameters (> 5 mm) were present when CSF pressure exceeded levels of 30 mm Hg. Retrospectively, discrimination between normal and elevated outflow resistance was possible on the basis of the ONS response to intrathecal infusion alone. It is concluded that the human ONS has sufficient elasticity to allow a detectable dilation in response to intracranial hypertension. Because of a variable pressure—diameter relationship, the subarachnoid pressure cannot be predicted exactly by single scans. Therefore, the clinical relevance of this method relies on the demonstration of pathologically enlarged sheaths or ongoing enlargement on serial ultrasonography studies.

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