Retinal optical coherence tomography shows optic disc changes in low intracranial pressure headaches: a case report

Excerpt

The optic disc is examined at the bedside as a simple and non-invasive indirect indicator of potentially elevated intracranial pressure. There is a large degree of physiological variation of optic disc appearance, but optic disc swelling (also called optic disc oedema) typically prompts further investigations for causes of potentially raised intracranial pressure [1]. In fact, it is the change of the translaminar pressure gradient at level of the lamina cribrosa which is a sensitive interface between cerebrospinal fluid (CSF) pressure and intraocular pressure (IOP) [2]. Minor pressure changes on both sides can lead to optic disc shape changes, as for example shown for increased intracranial pressure in idiopathic intracranial hypertension (IIH), for increased IOP in glaucoma or even with low ICP in patients with normal tension glaucoma and primary open angle glaucoma [3, 4]. However, the literature on the contribution of ICP in glaucomatous optic nerve damage is controversial [3, 5] and optic disc imaging in patients affected by low ICP state is lacking. Here, we demonstrate by optical coherence tomography (OCT), a non-invasive high-resolution technique, the changes in the optic disc in one patient with a low-pressure headache. To the best of our knowledge, this is the first case report of OCT documented optic disc excavation in a patient with a low intracranial pressure headache thought to be caused by a CSF leak. …