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

Autor: Schmidt B; Neurology, Klinikum Chemnitz gGmbH, Chemnitz, Germany., Czosnyka M; Brain Physics Laboratory, Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland., Cardim D; Neurology, The University of Texas Southwestern Medical Center, Dallas, United States., Czosnyka Z; Brain Physics Laboratory, Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland., Rosengarten B; Neurology, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
Jazyk: angličtina
Zdroj: Ultraschall in der Medizin (Stuttgart, Germany : 1980) [Ultraschall Med] 2023 Apr; Vol. 44 (2), pp. e91-e98. Date of Electronic Publication: 2021 Sep 08.
DOI: 10.1055/a-1586-6487
Abstrakt: 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 cmH 2 O, 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 cmH 2 O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH 2 O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH 2 O with both a sensitivity and specificity of 0.92. Presuming 20 cmH 2 O 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.
Competing Interests: B.S. and M.C. have financial interest in a part of licensing fee for non-invasive ICP plugin of ICM+ software.M.C. and Z.C. were supported by Revert Project, Interreg France (Channel Manche) England, funded by ERDF.
(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/).)
Databáze: MEDLINE
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