Papilloedema as a non-invasive marker for raised intra-cranial pressure following decompressive craniectomy for severe head injury

Joshua, Shejoy P; Agrawal, Deepak; Sharma, Bhawani S.; Mahapatra, Ashoka

doi:10.1016/j.clineuro.2011.05.012

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…This would be expected if elevated cerebrospinal fluid pressure were the only cause of raised VPP. [ 20 , 21 ] An additional finding was that lower age was associated with greater likelihood of a reduction in VPP in the glaucoma group (p = 0.0328). We did look to see if age interacted with treatment change (p = 0.1390) or change in IOP (p = 0.9949) in its association with a VPP reduction but could not find any such interaction.…”

Section: Discussionmentioning

confidence: 97%

Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure

et al. 2016

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PurposeTo explore whether alterations in intraocular pressure (IOP) affect vein pulsation properties using ophthalmodynamometric measures of vein pulsation pressure.Patients and MethodsGlaucoma patients had two retinal vein pulsation pressure (VPP) measurements from upper and lower hemiveins performed by ophthalmodynamometry at least 3 months apart. All subjects had VPP and IOP recorded at two visits, with standard automated perimetry, central corneal thickness (CCT) recorded at the initial visit. Where venous pulsation was spontaneous ophthalmodynamometry could not be performed and VPP was considered equal to IOP. Change in VPP was calculated and binarized with reduction in pressure scored 1 and no change or increase scored as 0. Data analysis used a mixed logistic regression model with change in VPP as response variable and change in IOP, visual field loss (mean deviation), CCT and time interval as explanatory variables.Results31 subjects (20 females) with mean age 60 years (sd 11) were examined with change in VPP being significantly associated with change in IOP (odds ratio 1.6/mmHg, 95% CI 1.2 to 2.1 in the glaucoma patients but not suspect patients (p = 0.0005).ConclusionChange in VPP is strongly associated with change in IOP such that a reduced intraocular pressure is associated with a subsequent reduction in VPP. This indicates that reduced IOP alters some retinal vein properties however the nature and time course of these changes is not known.

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Section: Discussionmentioning

confidence: 97%

Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure

et al. 2016

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“…The entity of the swelling can be graded by Frisén scale which includes 5 categories and it is built on ophthalmoscopic signs related to an increased mass or to swollen axons . This method showed a good accuracy for ICP detection in severe head‐injured patients .…”

Section: Indirect Pressure Transmissionmentioning

confidence: 99%

Non-invasive assessment of intracranial pressure

et al. 2015

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Monitoring of intracranial pressure (ICP) is invaluable in the management of neurosurgical and neurological critically ill patients. Invasive measurement of ventricular or parenchymal pressure is considered the gold standard for accurate measurement of ICP but is not always possible due to certain risks. Therefore, the availability of accurate methods to non-invasively estimate ICP has the potential to improve the management of these vulnerable patients. This review provides a comparative description of different methods for non-invasive ICP measurement. Current methods are based on changes associated with increased ICP, both morphological (assessed with magnetic resonance, computed tomography, ultrasound, and fundoscopy) and physiological (assessed with transcranial and ophthalmic Doppler, tympanometry, near-infrared spectroscopy, electroencephalography, visual-evoked potentials, and otoacoustic emissions assessment). At present, none of the non-invasive techniques alone seem suitable as a substitute for invasive monitoring. However, following the present analysis and considerations upon each technique, we propose a possible flowchart based on the combination of non-invasive techniques including those characterizing morphologic changes (e.g., repetitive US measurements of ONSD) and those characterizing physiological changes (e.g., continuous TCD). Such an integrated approach, which still needs to be validated in clinical practice, could aid in deciding whether to place an invasive monitor, or how to titrate therapy when invasive ICP measurement is contraindicated or unavailable.

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“…High ICP is the most frequent cause of death and disability after a severe traumatic brain injury [21,22,23]. ICP monitoring is recommended by all available guidelines for the management of severe traumatic brain injury [24,25].…”

Section: Discussionmentioning

confidence: 99%

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

et al. 2013

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Aim: The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. Methods: This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. Results: Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. Conclusions: Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.

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Papilloedema as a non-invasive marker for raised intra-cranial pressure following decompressive craniectomy for severe head injury

Cited by 9 publications

References 15 publications

Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure

Intraocular Pressure Reduction Is Associated with Reduced Venous Pulsation Pressure

Non-invasive assessment of intracranial pressure

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

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