Optic disc drusen mimicking Idiopathic Intracranial Hypertension (IIH): rely on ultrasound

Bakola, Eleni; Alonistiotis, Dimitrios; Arvaniti, Chrysa; Salakou, Stavroula; Nana, Niki; Foska, Aikaterini; Kotsali-Peteinelli, Vasiliki; Voumvourakis, Konstantinos; Tsivgoulis, Georgios

doi:10.1186/s42466-021-00133-0

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Optic nerve head drusen was responsible for 6% of misdiagnoses of IIH. B-scan ultrasound is considered diagnostic if there is an area of hyperreflectivity present at the nerve head or if acoustic shadowing of posterior structures of the optic nerve head is detected [ 33 ].…”

Section: Clinical Manifestations and Diagnosis Criteria Of Idiopathic...mentioning

confidence: 99%

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

Tuță

2022

Life

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In this review, we provide an update on the pathogenesis, diagnosis, and management of adults with idiopathic intracranial hypertension (IIH) and implications of the cerebral venous system, highlighting the progress made during the past decade with regard to mechanisms of the venous outflow pathway and its connection with the cerebral glymphatic and lymphatic network in genesis of IIH. Early diagnosis and treatment are crucial for favorable visual outcomes and to avoid vision loss, but there is also a risk of overdiagnosis and misdiagnosis in many patients with IIH. We also present details about treatment of intracranial hypertension, which is possible in most cases with a combination of weight loss and drug treatments, but also in selected cases with surgical interventions such as optic nerve sheath fenestration, cerebral spinal fluid (CSF) diversion, or dural venous sinus stenting for some patients with cerebral venous sinus stenosis, after careful analysis of mechanisms of intracranial hypertension, patient clinical profile, and method risks.

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Section: Clinical Manifestations and Diagnosis Criteria Of Idiopathic...mentioning

confidence: 99%

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

Tuță

2022

Life

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“…Although definitive differential diagnosis can be made using invasive method, LP, it is difficult to distinguish those two diseases with anamnesis and non-invasive techniques such as imaging modalities. [39][40][41][42] Despite studies showing a decrease in vessel density in cases of IIH and ODD compared with healthy controls, no study has compared those two groups. In our study, we therefore sough to evaluate the role of OCTA, which today's advancing technology offers, in the non-invasive differentiation of the two diseases.…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension

Yalçınkaya

Solmaz

Çakır

et al. 2023

European Journal of Ophthalmology

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Purpose To evaluate the changes in peripapillary microvascularity in idiopathic intracranial hypertension (IIH) and optic disc drusen (ODD) patients, by comparing them with those in healthy individuals, via optical coherence tomography angiography (OCTA). Methods Sixty-two eyes of 33 patients with ODD, 58 eyes of 30 patients with IIH, and 70 eyes of 70 healthy people were imaged for 6 × 6-mm optic disc scans on a spectral-domain OCTA. Vascular densities in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) of ODD, IIH, and healthy eyes were compared with a one-way analysis of variance. Post-hoc analysis was performed with the Gabriel test. Results There was a significant decrease in peripapillary vessel density in SCP, DCP, and CC in patients with IIH compared to the control group ( p < 0.05). In ODD patients, especially peripapillary vessel density in DCP was significantly reduced compared to the control group ( p < 0.05). Peripapillary vessel density in DCP was significantly lower in the IIH group than ODD group ( p < 0.05). Conclusions Peripapillary vascular density may be affected during the course of the disease in both IIH and ODD. Compared to healthy individuals, the decrease in vascular density in these patients and the consequent decrease in perfusion in the peripapillary region may guide the pathogenesis of the complications in the course of these two diseases. Although vascular density in DCP and CC differs significantly between IIH and ODD, case-controlled studies are needed to evaluate the role of OCTA in the differential diagnosis of IHH and ODD.

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“…TOS was performed by two trained neurologists (EB and GT), certified in neurosonology and with high expertise in TOS 9–12 . The operators were blinded to the clinical presentation and the final diagnosis of the patients.…”

Section: Methodsmentioning

confidence: 99%

“…TOS was performed by two trained neurologists (EB and GT), certified in neurosonology and with high expertise in TOS. [9][10][11][12] The operators were blinded to the clinical presentation and the final diagnosis of the patients. Philips CX50 Ultrasound System with a linear transducer at 9 MHz was used and TOS was performed prior to the lumbar puncture in all patients and before any therapeutic measures were initiated.…”

Section: Ultrasound Examinationmentioning

confidence: 99%

Transorbital sonography in idiopathic intracranial hypertension: Single‐center study, systematic review and meta‐analysis

Bakola,

Palaiodimou,

Eleftheriou

et al. 2023

Journal of Neuroimaging

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Background and PurposeTransorbital sonography (TOS) provides a noninvasive tool to detect intracranial pressure by assessing optic nerve sheath diameter (ONSD) and optic disc elevation (ODE). The utility of TOS in the diagnosis of idiopathic intracranial hypertension (IIH) has been increasingly recognized.MethodsA single‐center case‐control study sought to compare TOS‐acquired ONSD and ODE among IIH‐cases versus patients with other neurological diseases (controls). Furthermore, a systematic review and meta‐analysis was conducted to present pooled mean differences and diagnostic measures of ONSD and ODE between IIH‐cases and controls.ResultsIn the single‐center study, consisting of 31 IIH‐cases and 34 sex‐ and age‐matched controls, ONSD values were higher among IIH‐cases than controls (p<.001), while ODE was more prevalent in cases (65% vs. 15%; p<.001). The receiver‐operating characteristic (ROC)‐curve analysis revealed that the optimal cutoff value of ONSD for predicting IIH was 5.15 mm, with an area under the curve (AUC) of 0.914 (95% confidence interval [CI]: 0.861‐0.967) and sensitivity and specificity values of 85% and 90%, respectively. In a meta‐analysis of 14 included studies with 415 IIH‐cases, ONSD and ODE values were higher in IIH‐cases than controls (mean difference in ONSD 1.20 mm; 95% CI: 0.96‐1.44 mm and in ODE 0.3 mm; 95% CI: 0.33‐0.67 mm). With regard to ONSD, pooled sensitivity, specificity, and diagnostic odds ratio were calculated at 85.5% (95% CI: 77.9‐90.8%), 90.7% (95% CI: 84.6‐94.5%), and 57.394 (95% CI: 24.597‐133.924), respectively. The AUC in summary ROC‐curve analysis was 0.878 (95% CI: 0.858‐0.899) with an optimal cutoff point of 5.0 mm.ConclusionsTOS has a high diagnostic utility for the noninvasive diagnosis of IIH and may deserve wider implementation in everyday clinical practice.

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Optic disc drusen mimicking Idiopathic Intracranial Hypertension (IIH): rely on ultrasound

Cited by 5 publications

References 10 publications

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension

Transorbital sonography in idiopathic intracranial hypertension: Single‐center study, systematic review and meta‐analysis

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