Orbach Rotem, Schneebaum Sender Nira, Lubetzky Ronit, Fattal-Valevski Aviva
1 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
J Child Neurol. 2019 Feb;34(2):99-103. doi: 10.1177/0883073818811541. Epub 2018 Nov 27.
To assess the intracranial pressure in pediatric acute disseminated encephalomyelitis using spinal tap opening pressure on lumbar puncture, which is routinely performed as part of suspected acute disseminated encephalomyelitis workup. Compared to other cerebrospinal fluid parameters such as cell count, protein concentration, and presence of oligoclonal bands, cerebrospinal fluid opening pressure is infrequently recorded.
A retrospective chart review of demographic, clinical, and laboratory data of children diagnosed with acute disseminated encephalomyelitis admitted to a tertiary referral hospital between 2005 and 2016.
Of the 36 children diagnosed with acute disseminated encephalomyelitis, 24 had the cerebrospinal fluid opening pressure documented in their records. The mean cerebrospinal fluid opening pressure was 27.6±12.6 cmHO, range 9-55 cmHO (95% confidence interval 21.9-33.6). Cerebrospinal fluid opening pressure in the acute disseminated encephalomyelitis group was statistically significantly higher ( P = .0013, 95% confidence interval 4.2-15.0) than the accepted upper limit in this age group (18 cmHO). In 10 of 24 patients (42%), the opening pressure was above 28 cmHO.
Increased opening pressure was the most frequent cerebrospinal fluid abnormal finding in our cohort, which suggests a potential role of increased intracranial pressure in the acute disseminated encephalomyelitis pathophysiological disease mechanism. In certain cases, the opening pressure value could have monitoring and therapeutic implications, and therefore its measurement is highlighted by this study.
通过腰椎穿刺时的脊髓穿刺初压来评估小儿急性播散性脑脊髓炎的颅内压，腰椎穿刺作为疑似急性播散性脑脊髓炎检查的常规部分进行。与其他脑脊液参数如细胞计数、蛋白质浓度和寡克隆带的存在情况相比，脑脊液初压很少被记录。
对2005年至2016年期间入住三级转诊医院的诊断为急性播散性脑脊髓炎的儿童的人口统计学、临床和实验室数据进行回顾性图表审查。
在36例诊断为急性播散性脑脊髓炎的儿童中，有24例记录了脑脊液初压。脑脊液平均初压为27.6±12.6 cmH₂O，范围为9 - 55 cmH₂O（95%置信区间21.9 - 33.6）。急性播散性脑脊髓炎组的脑脊液初压在统计学上显著高于该年龄组公认的上限（18 cmH₂O）（P = .0013，95%置信区间4.2 - 15.0）。在24例患者中的10例（42%），初压高于28 cmH₂O。
初压升高是我们队列中最常见的脑脊液异常发现，这表明颅内压升高在急性播散性脑脊髓炎病理生理疾病机制中可能发挥作用。在某些情况下，初压值可能具有监测和治疗意义，因此本研究强调了其测量的重要性。
