Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
UCL Queen Square Institute of Neurology, London, United Kingdom.
JAMA Neurol. 2019 Dec 1;76(12):1502-1505. doi: 10.1001/jamaneurol.2019.2935.
A convenient and reliable method for noninvasive intracranial pressure assessments is desirable to reduce the need for invasive procedures (eg, intracranial pressure monitoring and lumbar punctures) and allow clinicians to identify and treat patients with intracranial hypertension in a timely manner.
To determine whether infrared video assessment of spontaneous retinal venous pulsation is associated with intracranial pressure and is a valid tool to indicate the presence or absence of raised intracranial pressure in patients without papilledema.
DESIGN, SETTING, AND PARTICIPANTS: A single-center prospective study was conducted at a tertiary referral center between January 2017 and May 2018. Patients consecutively admitted for clinically indicated elective 24-hour invasive intracranial pressure monitoring had ophthalmic review including infrared video recording of their spontaneous venous pulsation. Two neuro-ophthalmologists, who were masked to the intracranial pressure monitoring results, independently graded the spontaneous venous pulsation (grade 0 to 3). Analysis began in June 2018.
The association between simultaneously recorded intracranial pressure and spontaneous venous pulsation (binary variable: present/absent) assessed through retinal infrared video recordings was evaluated using a multiple linear regression model.
Of 105 patients, the mean (SD) age was 39 (14) years, and 79 (75%) were women. The mean (SD) simultaneous intracranial pressure was 1 (5) mm Hg for 91 patients (86.7%) with spontaneous venous pulsations and 13 (14) mm Hg for 14 patients (13.3%) without spontaneous venous pulsations. A multiple linear regression model adjusted for 7 potential confounders confirmed a statistically significant association between intracranial pressure and spontaneous venous pulsation (β = -9.1; 95% CI, -13.7 to -4.6; P < .001; adjusted R2 = 0.42).
The absence of spontaneous venous pulsation on retinal infrared video recordings is significantly associated with higher levels of intracranial pressure and should raise the suspicion of intracranial hypertension.
需要一种方便可靠的无创颅内压评估方法，以减少对有创操作（如颅内压监测和腰椎穿刺）的需求，并使临床医生能够及时识别和治疗颅内高压患者。
确定自发视网膜静脉搏动的红外视频评估是否与颅内压相关，并且是否是一种有效的工具，可以在没有视盘水肿的情况下指示颅内压升高的存在或不存在。
设计、设置和参与者：这是一项 2017 年 1 月至 2018 年 5 月在三级转诊中心进行的单中心前瞻性研究。连续收治的患者因临床指征需进行 24 小时有创颅内压监测，包括对自发静脉搏动进行红外视频记录的眼科检查。两位神经眼科医生对颅内压监测结果进行了盲法评估，他们独立对自发静脉搏动进行分级（0 级至 3 级）。分析于 2018 年 6 月开始。
使用多元线性回归模型评估同时记录的颅内压和自发静脉搏动（二项变量：存在/不存在）之间的相关性，通过视网膜红外视频记录进行评估。
在 105 例患者中，平均（SD）年龄为 39（14）岁，79 例（75%）为女性。91 例（86.7%）有自发静脉搏动的患者平均（SD）同时颅内压为 1（5）mmHg，14 例（13.3%）无自发静脉搏动的患者平均（SD）颅内压为 13（14）mmHg。经 7 个潜在混杂因素调整的多元线性回归模型证实，颅内压与自发静脉搏动之间存在统计学显著关联（β=-9.1；95%CI，-13.7 至-4.6；P<.001；调整后的 R2=0.42）。
视网膜红外视频记录中自发静脉搏动的缺失与较高的颅内压显著相关，应引起颅内高压的怀疑。
