Noninvasive methods of detecting increased intracranial pressure

Abstract

The detection of elevated intracranial pressure (ICP) is of paramount importance in the diagnosis and management of a number of neurologic pathologies. The current gold standard is the use of intraventricular or intraparenchymal catheters; however, this is invasive, expensive, and requires anesthesia. On the other hand, diagnosing intracranial hypertension based on clinical symptoms such as headaches, vomiting, and visual changes lacks sensitivity. As such, there exists a need for a noninvasive yet accurate and reliable method for detecting elevated ICP. In this review, we aim to cover both structural modalities such as computed tomography (CT), magnetic resonance imaging (MRI), ocular ultrasound, fundoscopy, and optical coherence tomography (OCT) as well as functional modalities such as transcranial Doppler ultrasound (TCD), visual evoked potentials (VEPs), and near-infrared spectroscopy (NIRS).

The diagnostic challenge of evaluating papilledema in the pediatric patient

“…This increased pressure results in disruption of axonal transport at the level of the lamina cribosa and subsequent increased thickness of the RNFL. [15] As the axons swell, they compress the retinal veins and cause venous engorgement and capillary leakage. [3] Fundus examination characteristically shows variable findings, including elevation of the optic disc, blurring of the disc margin, opacification of the RNFL, and blurring of the retinal vessels.…”

“…[3] Imaging modalities may show increased RNFL thickness, total retinal thickness, and optic nerve head volume. [15] However, the presence of these findings may not distinguish mild papilledema and pseudopapilledema based on a single measurement. A follow-up scan weeks to months later may show increase in these parameters in true papilledema and stable measurements in pseudopapilledema.…”

Intracranial Venous Sinuses Characteristics Prior To And Following Resection Of Brain Tumors

“…Several imaging techniques exist in order to demonstrate the presence of elevated intracranial pressure. These non-invasive methods rely on indirect signs suggesting elevated ICP, and include typical characteristics in computed tomography (CT), magnetic resonance imaging (MRI), ophthalmological ultrasound, trans-cranial Doppler, direct fundoscopy and optic nerves electrical potentials measurements [23]. During the last few years, several studies described narrowing of the large cerebral venous sinuses among patients suffering from increased ICP, mainly following the diagnosis of Idiopathic Intracranial Hypertension (IIH).…”

Our Experience of Hyperosmolar Treatment in Patients with Traumatic Brain Injury in Pediatric Intensive Care Unit

“…Invasive ICP measurement with an external ventricular drain or an intraparenchymal ICP monitor definitively reveals the presence of intracranial hypertension (>20 mmHg). These measurements are performed in cases of severe TBI following head trauma with a GCS score ≤8 and potential complications, such as infection or bleeding [12,13] . We could not perform invasive ICP monitoring on any of our patients due to technical limitations.…”