Venous ophthalmodynamometry: a noninvasive method for assessment of intracranial pressure

Teramoto

Neurol. Med. Chir.(Tokyo)

et al. 2002

A 62-year-old woman presented with rapidly developed visual disturbance without associated headache or nausea 3 weeks after head injury. Ophthalmologic examination revealed bilateral severe papilledema with retinal hemorrhage, and intracranial pressure (ICP) was 17.5 cmH 2 O estimated by lumbar puncture. Computed tomography and magnetic resonance (MR) imaging showed no evidence of increased ICP, except dilation of the subarachnoid space around the optic nerves with distortion of the nerves. Her visual acuity remarkably improved after steroid and glycerol treatment, and optic fundus examination revealed bilateral clear optic papillae without atrophic changes. Follow-up MR imaging demonstrated that the bilateral optic nerves had regained the normal appearance. These results indicate that the bilateral papilledema was caused by increased subarachnoid pressure around the bilateral optic nerves. We conclude that papilledema can occur with a mildly increased ICP and trapped subarachnoid cerebrospinal fluid around the optic nerves, and papilledema may progress after the ICP is normalized. Papilledema is a warning sign for increased ICP, associated with future visual loss from retinal hemorrhage. Therefore, repeated funduscopic investigation is necessary for the early diagnosis and treatment of papilledema.

Section: Discussionmentioning

confidence: 99%

Severe Papilledema Identified 3 Weeks After Head Injury. Case Report.

Teramoto

Neurol. Med. Chir.(Tokyo)

et al. 2002

Invest. Ophthalmol. Vis. Sci.

“…2 Vein pulsation pressure is linearly associated with intracranial pressure, and the presence or absence of spontaneous venous pulsation is a useful clinical sign for the assessment of elevated intracranial pressure. 12 Vein pulsation pressure can be measured in only 2% to 5% of normal subjects and 46% of glaucoma subjects by ophthalmodynamometry, although in a greater proportion of subjects with raised intracranial pressure. 7,13 It is a subjective measurement, with the ''minimal detectable pulsation'' threshold varying between observers.…”

mentioning

confidence: 99%

Photoplethysmographic Measurement of Various Retinal Vascular Pulsation Parameters and Measurement of the Venous Phase Delay

Morgan

Hazelton

Betz‐Stablein

et al. 2014

PURPOSE. Retinal vein pulsation properties are altered by glaucoma, intracranial pressure (ICP) changes, and retinal venous occlusion, but measurements are limited to threshold measures or manual observation from video frames. We developed an objective retinal vessel pulsation measurement technique, assessed its repeatability, and used it to determine the phase relations between retinal arteries and veins.METHODS. Twenty-three eyes of 20 glaucoma patients had video photograph recordings from their optic nerve and peripapillary retina. A modified photoplethysmographic system using video recordings taken through an ophthalmodynamometer and timed to the cardiac cycle was used. Aligned video frames of vessel segments were analyzed for blood column light absorbance, and waveform analysis was applied. Coefficient of variation (COV) was calculated from data series using recordings taken within 61 unit ophthalmodynamometric force of each other. The time in cardiac cycles and seconds of the peak (dilation) and trough (constriction) points of the retinal arterial and vein pulse waveforms were measured.RESULTS. Mean vein peak time COV was 3.4%, and arterial peak time COV was 4.4%. Lower vein peak occurred at 0.044 cardiac cycles (0.040 seconds) after the arterial peak (P ¼ 0.0001), with upper vein peak an insignificant 0.019 cardiac cycles later. No difference in COV for any parameter was found between upper or lower hemiveins. Mean vein amplitude COV was 12.6%, and mean downslope COV was 17.7%. CONCLUSIONS.This technique demonstrates a small retinal venous phase lag behind arterial pulse. It is objective and applicable to any eye with clear ocular media and has moderate to high reproducibility. (http://www.anzctr.org.au number, ACTRN12608000274370.)

“…The study may add to the clinical application of modern ophthalmodynamometry as already demonstrated in previous investigations on glaucoma, measurement of intracerebral pressure, assessment of tissue pressure in the orbit in patients with endocrine orbitopathy, ischaemic ophthalmopathy and retinal vein occlusions. [4][5][6][7][8][9][10][11][12] …”

Section: Resultsmentioning

confidence: 99%

Central retinal artery and vein collapse pressure in giant cell arteritis versus nonarteritic anterior ischaemic optic neuropathy

Jonas

Harder

2007

Eye

Arteritic anterior ischaemic optic neuropathy and nonarteritic anterior ischaemic optic neuropathy are acute optic neuropathies, which have to be differentiated from each other. It was the purpose of this study to assess whether ophthalmodynamometry with an assessment of the collapse pressure of the central retinal artery (CRA) and vein (CRV) is helpful for that. Using a Goldmann contact lens-associated ophthalmodynamometer, the diastolic collapse pressure of the CRA and CRV were measured in six patients (eight eyes) with giant cell arteritis-induced anterior ischaemic optic neuropathy (GC-AION) and in 10 patients (12 eyes) with acute non-arteritic anterior ischaemic optic neuropathy (NAION). CRA collapse pressure was significantly (P ¼ 0.001; 95% confidence interval (CI): À68.7, À20.0) lower in the GC-AION group (52.7724.6 arbitrary units) than in the NAION group (97.0725.8 arbitrary units). CRV collapse pressure did not vary significantly (P ¼ 0.47). As measured by ophthalmodynamometry, CRA pressure is significantly lower in GC-AION than in NAION. CRV pressure does not vary markedly. These finding may be helpful for the clinical differentiation between GC-AION and NAION, and may give hints for the pathogenesis.