Position-Related Variability of CSF Opening Pressure Measurements

Schwartz, Kara M.; Luetmer, Patrick H.; Hunt, Christopher H.; Kotsenas, Amy L.; Diehn, Felix E.; Eckel, L. J.; Black, David F.; Lehman, Vance T.; Lindell, E. Paul

doi:10.3174/ajnr.a3313

Cited by 40 publications

(26 citation statements)

References 12 publications

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“…This may explain why only three patients in our study with pseudopapilledema had lumbar punctures performed. Although spinal fluid analysis is indicated to rule out other etiologies for raised intracranial pressure, opening pressure measurements can potentially vary in some patients based on many factors such as patient positioning with prone position recordings being higher than lateral decubitus, 21,22 Valsalva maneuvers, 23 effect of anesthesia, 24 and cannot be solely relied upon in making an accurate diagnosis. In our study, there was one patient who had CSF opening pressure measurement of 24 cm of H 2 O who had normal ultrasound and clinical features suspicious for papilledema and one patient in the pseudopapilledema category with 25 cm H 2 O of opening pressure.…”

Section: Discussionmentioning

confidence: 99%

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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Purpose To determine the sensitivity and specificity of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in adult patients. Methods The records of all adult patients referred to the neuro-ophthalmology service who underwent orbital ultrasonography for the evaluation of suspected papilledema were reviewed. The details of history, ophthalmologic examination, and results of ancillary testing including orbital ultrasonography, MRI, and lumbar puncture were recorded. Results of orbital ultrasonography were correlated with the final diagnosis of papilledema or pseudopapilledema on the basis of the clinical impression of the neuro-ophthalmologist. Ultrasound was considered positive when the optic nerve sheath diameter was Z3.3 mm along with a positive 301 test. Results The sensitivity of orbital ultrasonography for detection of papilledema was 90% (CI: 80.2-99.3%) and the specificity in detecting pseudopapilledema was 79% (CI: 67.7-90.7%). Conclusions Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive, but less specific in differentiating papilledema from pseudopapilledema in adult patients, and can be useful in guiding further management of patients in whom the diagnosis is initially uncertain.

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Section: Discussionmentioning

confidence: 99%

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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“…Although some argue that patient positioning can significantly affect opening pressure;[22] other studies have demonstrated that opening pressure measured in the prone position as essentially equivalent to the lateral decubitus position. [23] Thus, some recommend performing lumbar puncture with the patient in the lateral decubitus position to avoid this error, but we utilize prone positioning under fluoroscopy at our center.…”

Section: Papilledemamentioning

confidence: 99%

The diagnostic challenge of evaluating papilledema in the pediatric patient

McCafferty

McClelland

Lee

2017

Taiwan J Ophthalmol

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Pseudopapilledema is a fairly common finding in ophthalmic practice, and in many cases, the diagnosis is straightforward. However, an accurate diagnosis can challenge the most seasoned clinicians, and missing true papilledema can result in life-threatening or vision-threatening consequences. In this review, we describe the clinical findings and a diagnostic algorithm to distinguish pseudopapilledema and papilledema in the pediatric patients. We also describe the clinical evaluation once a diagnosis of papilledema has been established.

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“…29 In 163 CSFP was measured using the fluoroscopy-guided lumbar puncture technique, 164 which was conducted on the same day as the ophthalmic examination. 30 In brief, the Table 2 gives the translaminar pressure parameters (i.e., baseline IOP, CSFP, and so multivariate analysis was performed in two ways to avoid multicollinearity.…”

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confidence: 99%