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Utility of Transcranial Doppler in Idiopathic Intracranial Hypertension

Published online by Cambridge University Press:  02 December 2014

Gary Hunter ,
Chris Voll  and
Michele Rajput
Gary Hunter*
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Chris Voll
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Michele Rajput
Affiliation:
Department of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Department of Clinical Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
*
695 Oakcrossing Road, London, Ontario, N6H 5V7, Canada.
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Abstract

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Introduction:

Idiopathic intracranial hypertension (IIH) can be an elusive diagnosis, and poor visual outcomes may occur. Currently, the only means of accurately diagnosing and following these patients is with repeated lumbar puncture. Previous work has shown that transcranial doppler measurements of pulsatility correlate accurately with elevated intracranial pressure (ICP). This study is designed to assess whether pulsatility index (PI) correlates with ICP in patients newly diagnosed with IIH.

Methods:

Seven patients with clinical suspicion of IIH were included in this study. Clinical suspicion was based on history of recurrent headaches and papilledema. All patients had otherwise normal examinations and imaging. Middle cerebral arteries were insonated to obtain average PI values. Cerebrospinal fluid (CSF) was then withdrawn, and closing pressures were recorded. Pulsatility index values were then obtained again, within ten minutes after completing CSF withdrawal. PI values were correlated with ICP values, and pre and post CSF withdrawal values were compared.

Results:

All seven patients had elevated opening pressures (average 39 cm H2O, range 27-70). The average closing pressure after approximately 30 cc of CSF withdrawal was 11.9 cm H2O. The average PI before CSF withdrawal was 0.95, which dropped to 0.70 after CSF withdrawal (p = 0.02). The change in ICP was found to be correlated with a change in PI (p = 0.004).

Conclusions:

These findings suggest that PI may be useful for following patients with IIH non-invasively. Further study with larger groups and blinded assessments should be useful in better characterizing the accuracy of this technique.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 2 , March 2010 , pp. 235 - 239
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Durcan, FJ, Corbett, JJ, Wall, M. The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch Neurol. 1988 Aug;45(8):875–7.Google Scholar
2. Janny, P, Chazal, J, Colnet, G, Irthum, B, Georget, AM. Benign intracranial hypertension and disorders of CSF absorption. Surg Neurol. 1981 Mar;15(3):168–74.CrossRefGoogle ScholarPubMed
3. Karahalios, DG, Rekate, HL, Khayata, MH, Apostolides, PJ. Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology. 1996 Jan;46(1):198–202.CrossRefGoogle ScholarPubMed
4. Ball, AK, Clarke, CE. Idiopathic intracranial hypertension. Lancet Neurol. 2006 May;5(5):433–42.CrossRefGoogle ScholarPubMed
5. Higgins, JN, Cousins, C, Owler, BK, Sarkies, N, Pickard, JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry. 2003 Dec;74(12):1662–6.CrossRefGoogle ScholarPubMed
6. Owler, BK, Allan, R, Parker, G, Besser, M. Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment. Br J Neurosurg. 2003 Feb;17(1):79–83.CrossRefGoogle ScholarPubMed
7. King, JO, Mitchell, PJ, Thomson, KR, Tress, BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology. 1995 Dec;45(12):2224–8.Google Scholar
8. Keltner, JL, Johnson, CA, Quigg, JM, Cello, KE, Kass, MA, Gordon, MO. Confirmation of visual field abnormalities in the Ocular Hypertension Treatment Study. Ocular Hypertension Treatment Study Group. Arch Ophthalmol. 2000 Sep;118(9):1187–94.Google Scholar
9. Gu, XZ, Tsai, JC, Wurdeman, A, Wall, M, Foote, T, Sadun, AA. Pattern of axonal loss in longstanding papilledema due to idiopathic intracranial hypertension. Arch Ophthalmol. 2000 Sep;118(9):1187–94.Google Scholar
10. Bellner, J, Romner, B, Reinstrup, P, Kristiansson, KA, Ryding, E, Brandt, L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004 Jul;62(1):45–51.CrossRefGoogle ScholarPubMed
11. Gur, AY, Kesler, A, Shopin, L, Bornstein, NM. Transcranial Doppler for evaluation of idiopathic intracranial hypertension. Acta Neurol Scand. 2007 Oct;116(4):239–42.Google Scholar
12. Aggarwal, S, Brooks, DM, Kang, Y, Linden, PK, Patzer, JF 2nd. Noninvasive monitoring of cerebral perfusion pressure in patients with acute liver failure using transcranial doppler ultrasonography. Liver Transpl. 2008 Jul;14(7):1048–57.Google Scholar