Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator

Abstract

ObjectiveSpontaneous intracranial hypotension (SIH) is most commonly caused by cerebrospinal fluid (CSF) leakage. Therefore, we hypothesised that patients with orthostatic headache (OH) would show decreased optic nerve sheath diameter (ONSD) during changes from supine to upright position.MethodsTransorbital B-mode ultrasound was performed employing a high-frequency transducer for ONSD measurements in the supine and upright positions. Absolute values and changes of ONSD from supine to upright were assessed. Ultrasound was performed in 39 SIH patients, 18 with OH and 21 without OH, and in 39 age-matched control subjects. The control group comprised 20 patients admitted for back surgery without headache or any orthostatic symptoms, and 19 healthy controls.ResultsIn supine position, mean ONSD (±SD) was similar in patients with (5.38±0.91 mm) or without OH (5.48±0.89 mm; p=0.921). However, in upright position, mean ONSD was different between patients with (4.84±0.99 mm) and without OH (5.53±0.99 mm; p=0.044). Furthermore, the change in ONSD from supine to upright position was significantly greater in SIH patients with OH (−0.53±0.34 mm) than in SIH patients without OH (0.05±0.41 mm; p≤0.001) or in control subjects (0.01±0.38 mm; p≤0.001; area under the curve: 0.874 in receiver operating characteristics analysis).ConclusionsSymptomatic patients with SIH showed a significant decrease of ONSD, as assessed by ultrasound, when changing from the supine to the upright position. Ultrasound assessment of the ONSD in two positions may be a novel, non-invasive tool for the diagnosis and follow-up of SIH and for elucidating the pathophysiology of SIH.

Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis

“…). A total of 34 studies provided mean values for ONSD measurement . The pool of mean ONSD measurements was 4.78 mm (95% CI, 4.63‐4.94 mm; Fig.…”

Cryptogenic Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Role of Dynamic CT Myelography

“…As described previously (3,5), transorbital US in the supine and upright positions was performed first (6). Native MRI of the entire spine, including sagittal T1-and T2-weighted imaging and an isotropic three-dimensional T2-weighted turbo spinecho sequence with fat saturation was followed by intrathecal gadolinium-enhanced MRI of the spine.…”

Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series

“…The measure of the superior ophthalmic vein diameter by color Doppler flow has been proposed by Chen et al According to the author, a low blood flow in theses veins could reflect the low CSF pressure volume. Fichtner et al demonstrated a significant decrease of optic nerve sheath diameter measured by transorbital ultrasound in spontaneous intracranial hypotension (SIH) from supine to upright position . The author also confirmed a significant change of this diameter in SIH before and after microsurgical sealing of the cerebrospinal fluid leak .…”