Reference Range for Cerebrospinal Fluid Opening Pressure in Children

Avery, R. A.; Shah, Samir S.; Licht, Daniel J.; Seiden, Jeffrey A.; Huh, Jimmy W.; Boswinkel, Jan; Ruppe, Michael; Chew, Amber; Mistry, Rakesh D.; Liu, Grant T.

doi:10.1056/nejmc1004957

Cited by 247 publications

(191 citation statements)

References 6 publications

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“…Despite 2 pediatric studies suggesting a normal OP in children can be as high as 28 cm of water (cm H 2 O), 14,16 we defined thresholds for an elevated OP as both 20 cm H 2 O and 28 cm H 2 O to avoid potentially excluding children with a mildly elevated OP. In both centers, when the OP was beyond the length of the manometer, the clinician recorded a "greater than" reading.…”

Section: Methodsmentioning

confidence: 99%

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Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Retinal hemorrhage (RH) is an important sign of pediatric abusive head trauma. Raised intracranial pressure (ICP) is sometimes proposed as an alternate cause of RH in children being evaluated for possible child abuse.WHAT THIS STUDY ADDS: Nontraumatic, markedly elevated ICP rarely causes RH in children. When it does, RH are superficial intraretinal and located adjacent to a swollen optic nerve head. This pattern does not match the widespread pattern seen in abusive head trauma. abstract OBJECTIVE: Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP). METHODS:Children undergoing LP as part of their routine clinical care were studied prospectively at the Children' s Hospital of Philadelphia and retrospectively at Nationwide Children' s Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) $20 cm of water (cm H 2 O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist. RESULTS:One hundred children were studied (mean age: 12 years; range: 3-17 years). Mean OP was 35 cm H 2 O (range: 20-56 cm H 2 O); 68 (68%) children had OP .28 cm H 2 O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H 2 O). CONCLUSIONS:Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause. Pediatrics 2013;132:e430-e434 AUTHORS:

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Section: Methodsmentioning

confidence: 99%

“…Data were collected as part of a prospective study of children undergoing LP during their routine clinical care in Philadelphia between January 2007 and February 2009 14 ; the data were collected retrospectively in Columbus. In both centers, subjects were enrolled consecutively.…”

Section: Methodsmentioning

confidence: 99%

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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“…Because IIH in young children appears to be different compared to adolescents and adults, Rangwala and Liu [13] proposed new diagnostic criteria for IIH in prepubertal children. In the setting of newly published reference ranges for CSF in children [14], we have modified the proposed diagnostic criteria for pediatric IIH (table 2). …”

Section: Demographics and Diagnostic Criteriamentioning

confidence: 99%

Pediatric Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Liu²

2010

Horm Res Paediatr

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Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a condition of elevated intracranial pressure in the absence of clinical, laboratory or radiological evidence of an intracranial space occupying lesion that can occur in the pediatric population. While IIH is more commonly recognized as a disorder of adults, it affects children of all ages and can have distinctive characteristics when presenting in the prepubertal age group. This review discusses the demographics, clinical presentation, diagnosis, neuroimaging, and management of pediatric IIH. Common etiologies of IIH in children, with particular focus on endocrine abnormalities, are highlighted.

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“…Previous studies have noted several factors that may increase OP during lumbar puncture, including sedation or anesthesia, 1,4 Valsalva maneuvers, 5 uncooperative patients requiring restraint, 6 and flexion versus extension of the legs and body. [6][7][8][9] Authors have suggested that increased CSF pressure may be seen with changes in body position due to increases in venous pressure, which is related to cerebral perfusion pressure and, therefore, CSF pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Normal OP values have been established with patients in this position. 1,2 However, lumbar punctures with fluoroscopy are typically performed with the patient prone, and OP measurements are most often obtained in the prone position. 3 At our institution, 3 techniques are used to measure OP, depending on the preference of the operator performing the lumbar puncture, with fluoroscopic guidance.…”

mentioning

confidence: 99%

Position-Related Variability of CSF Opening Pressure Measurements

Schwartz

Luetmer

Hunt

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Normative data for CSF OP have previously been established with patients in the LD position. During fluoroscopically guided LP procedures, radiologists frequently obtain these OP measurements with patients prone. In this prospective study, our goal was to determine the variability of OP measurements as a function of patient positioning and to assess whether there is a relationship with patient BMI.

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Reference Range for Cerebrospinal Fluid Opening Pressure in Children

Cited by 247 publications

References 6 publications

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Pediatric Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Position-Related Variability of CSF Opening Pressure Measurements

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