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General neurology
Research paper
Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator
  1. Jens Fichtner1,
  2. Christian T Ulrich1,
  3. Christian Fung1,
  4. Christin Knüppel2,
  5. Martina Veitweber2,
  6. Astrid Jilch1,
  7. Philippe Schucht1,
  8. Michael Ertl2,
  9. Beate Schömig2,
  10. Jan Gralla3,
  11. Werner J Z'Graggen1,4,
  12. Corrado Bernasconi5,
  13. Heinrich P Mattle4,
  14. Felix Schlachetzki2,
  15. Andreas Raabe1,
  16. Jürgen Beck1
  1. 1Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
  2. 2Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
  3. 3Institute of Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
  4. 4Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
  5. 5Clinical Trial Unit, Neurocenter Bern, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Jürgen Beck, Department of Neurosurgery, Inselspital, Bern University Hospital, Bern 3010, Switzerland; juergen.beck{at}insel.ch

Abstract

Objective Spontaneous intracranial hypotension (SIH) is most commonly caused by cerebrospinal fluid (CSF) leakage. Therefore, we hypothesised that patients with orthostatic headache (OH) would show decreased optic nerve sheath diameter (ONSD) during changes from supine to upright position.

Methods Transorbital B-mode ultrasound was performed employing a high-frequency transducer for ONSD measurements in the supine and upright positions. Absolute values and changes of ONSD from supine to upright were assessed. Ultrasound was performed in 39 SIH patients, 18 with OH and 21 without OH, and in 39 age-matched control subjects. The control group comprised 20 patients admitted for back surgery without headache or any orthostatic symptoms, and 19 healthy controls.

Results In supine position, mean ONSD (±SD) was similar in patients with (5.38±0.91 mm) or without OH (5.48±0.89 mm; p=0.921). However, in upright position, mean ONSD was different between patients with (4.84±0.99 mm) and without OH (5.53±0.99 mm; p=0.044). Furthermore, the change in ONSD from supine to upright position was significantly greater in SIH patients with OH (−0.53±0.34 mm) than in SIH patients without OH (0.05±0.41 mm; p≤0.001) or in control subjects (0.01±0.38 mm; p≤0.001; area under the curve: 0.874 in receiver operating characteristics analysis).

Conclusions Symptomatic patients with SIH showed a significant decrease of ONSD, as assessed by ultrasound, when changing from the supine to the upright position. Ultrasound assessment of the ONSD in two positions may be a novel, non-invasive tool for the diagnosis and follow-up of SIH and for elucidating the pathophysiology of SIH.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/jnnp-2015-310853

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