D'Antona Linda, Asif Hasan, Craven Claudia Louise, McHugh James Alexander, Vassiliou Anna, Thorne Lewis, Matharu Manjit Singh, Watkins Laurence Dale, Bremner Fion, Toma Ahmed Kassem
From the National Hospital for Neurology and Neurosurgery (L.D., H.A., C.L.C., A.V., L.T., M.S.M., L.D.W., F.B., A.K.); Victor Horsley Department of Neurosurgery (L.D., H.A., C.L.C., A.V., L.T., L.D.W., A.K.); UCL Queen Square Institute of Neurology (L.D., M.S.M., L.D.W., F.B., A.K.); King's College Hospital NHS Foundation Trust (J.A.M.); Department of Ophthalmology (J.A.M., F.B.); and Headache and Facial Pain Group (M.S.M.), London, UK.. linda.d'
From the National Hospital for Neurology and Neurosurgery (L.D., H.A., C.L.C., A.V., L.T., M.S.M., L.D.W., F.B., A.K.); Victor Horsley Department of Neurosurgery (L.D., H.A., C.L.C., A.V., L.T., L.D.W., A.K.); UCL Queen Square Institute of Neurology (L.D., M.S.M., L.D.W., F.B., A.K.); King's College Hospital NHS Foundation Trust (J.A.M.); Department of Ophthalmology (J.A.M., F.B.); and Headache and Facial Pain Group (M.S.M.), London, UK..
Neurology. 2021 May 31;96(22):e2714-e2723. doi: 10.1212/WNL.0000000000012023.
To evaluate the utility of brain MRI and ophthalmic biomarkers for the prediction of intracranial hypertension, we have studied the association between 6 biomarkers and 24-hour intracranial pressure (ICP) monitoring results in 45 patients.
This single-center observational study includes patients who underwent 24-hour ICP monitoring, brain MRI (within 3 months), and ophthalmic assessment (during ICP monitoring). Six biomarkers were investigated: pituitary gland shape, vertical tortuosity of the optic nerve, distension of the optic nerve sheath, optic disc protrusion (MRI), papilledema (slit lamp biomicroscopy), and spontaneous venous pulsations (SVP, infrared video recordings).
Forty-five patients (mean age 39 ± 14 years, 38 women) met the inclusion criteria. All 6 biomarkers had a significant association with 24-hour ICP. Concave pituitary gland was observed with moderately elevated median ICP. Protrusion of the optic disc (MRI), papilledema, and absence of SVP were associated with the highest median ICP values. Twenty patients had raised ICP (median 24-hour ICP >5.96 mm Hg, cutoff obtained through Youden index calculation). Patients with all normal biomarkers had normal median ICP in 94% (standard error 6%) of the cases. All patients with ≥3 abnormal biomarkers had intracranial hypertension. The combination of at least 1 abnormal biomarker in MRI and ophthalmic assessments was highly suggestive of intracranial hypertension (area under the curve 0.94, 95% confidence interval 0.93-0.94) CONCLUSIONS: Brain MRI and ophthalmic biomarkers can noninvasively guide the management of patients with suspected CSF dynamics abnormalities. Patients with multiple abnormal biomarkers (≥3) or a combination of abnormal MRI and ophthalmic biomarkers are likely to have intracranial hypertension and should be managed promptly.
为评估脑磁共振成像（MRI）和眼科生物标志物对颅内高压预测的效用，我们研究了45例患者中6种生物标志物与24小时颅内压（ICP）监测结果之间的关联。
这项单中心观察性研究纳入了接受24小时ICP监测、脑MRI（3个月内）和眼科评估（ICP监测期间）的患者。研究了6种生物标志物：垂体形态、视神经垂直迂曲度、视神经鞘扩张、视盘突出（MRI）、视乳头水肿（裂隙灯生物显微镜检查）和自发性静脉搏动（SVP，红外视频记录）。
45例患者（平均年龄39±14岁，38例女性）符合纳入标准。所有6种生物标志物均与24小时ICP显著相关。垂体呈凹形与ICP中位数中度升高相关。视盘突出（MRI）、视乳头水肿和无SVP与ICP中位数最高值相关。20例患者ICP升高（24小时ICP中位数>5.96 mmHg，通过约登指数计算得出截断值）。所有生物标志物均正常的患者中，94%（标准误6%）的病例ICP中位数正常。所有≥3种生物标志物异常的患者均有颅内高压。MRI和眼科评估中至少有1种异常生物标志物的组合高度提示颅内高压（曲线下面积0.94，95%置信区间0.93 - 0.94）。结论：脑MRI和眼科生物标志物可无创指导疑似脑脊液动力学异常患者的管理。多种生物标志物异常（≥3种）或MRI与眼科生物标志物组合异常的患者可能患有颅内高压，应及时进行处理。
