Association of Intracranial Pressure and Spontaneous Retinal Venous Pulsation

Abstract

IMPORTANCE A convenient and reliable method for noninvasive intracranial pressure assessments is desirable to reduce the need for invasive procedures (eg, intracranial pressure monitoring and lumbar punctures) and allow clinicians to identify and treat patients with intracranial hypertension in a timely manner.OBJECTIVE To determine whether infrared video assessment of spontaneous retinal venous pulsation is associated with intracranial pressure and is a valid tool to indicate the presence or absence of raised intracranial pressure in patients without papilledema. DESIGN, SETTING, AND PARTICIPANTSA single-center prospective study was conducted at a tertiary referral center between January 2017 and May 2018. Patients consecutively admitted for clinically indicated elective 24-hour invasive intracranial pressure monitoring had ophthalmic review including infrared video recording of their spontaneous venous pulsation. Two neuro-ophthalmologists, who were masked to the intracranial pressure monitoring results, independently graded the spontaneous venous pulsation (grade 0 to 3). Analysis began in June 2018. MAIN OUTCOMES AND MEASURESThe association between simultaneously recorded intracranial pressure and spontaneous venous pulsation (binary variable: present/absent) assessed through retinal infrared video recordings was evaluated using a multiple linear regression model. RESULTSOf 105 patients, the mean (SD) age was 39 (14) years, and 79 (75%) were women. The mean (SD) simultaneous intracranial pressure was 1 (5) mm Hg for 91 patients (86.7%) with spontaneous venous pulsations and 13 (14) mm Hg for 14 patients (13.3%) without spontaneous venous pulsations. A multiple linear regression model adjusted for 7 potential confounders confirmed a statistically significant association between intracranial pressure and spontaneous venous pulsation (β = −9.1; 95% CI, −13.7 to −4.6; P < .001; adjusted R 2 = 0.42). CONCLUSIONS AND RELEVANCEThe absence of spontaneous venous pulsation on retinal infrared video recordings is significantly associated with higher levels of intracranial pressure and should raise the suspicion of intracranial hypertension.

Heart rate and age modulate retinal pulsatile patterns

“…Therefore, the unverified biological impact of HR and age at RPP morphology was in vivo confirmed and validated. The impact of HR and age on the SVP/OCP morphology has been neglected in previous clinical research 4 , 19 , 33 , 34 , 43 and even in theoretical SVP-intracranial/intraocular pressure models 35 , 36 . The in vivo findings validate Levine and Bebie’s theory, assuming that SVP Ampl is influenced by HR 37 , 38 .…”

Current Perspectives on Idiopathic Intracranial Hypertension without Papilloedema

“…The tree shrew is proving to be a promising model [ 48 ]. Using OCT, the absence of SVP on retinal infrared video recordings is associated with higher levels of ICP and should raise the suspicion of intracranial hypertension in those with papilloedema [ 49 ]. Critics may consider OCT, and ophthalmic clinical examination to be redundant in IIHWOP; however, Halsey presented a case with no papilledema and no SVP, whom he suspected had IIHWOP and following LP, SVP was evident on clinical examination [ 50 ].…”

Non-invasive detection of intracranial pressure related to the optic nerve

“…D'Antona et al performed multiple linear regression analyses on 105 patients and confirmed that there was a significant correlation between ICP and spontaneous venous pulsation (r=-9.1; 95% CI: -13.7 to -4.6, P<0.001, adjusted R 2 =0.42). They found that infrared video assessment of spontaneous retinal vein pulsation was an effective indicator of elevated ICP in patients without papilledema (81). However, this method was limited to patients without papilloma, so its scope of application was limited (82).…”