Ultrasound-guided initial diagnosis and follow-up of pediatric idiopathic intracranial hypertension

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Date

2024-03-20

Authors

Kerscher, Susanne Regina
Zipfel, Julian
Haas-Lude, Karin
Bevot, Andrea
Schuhmann, Martin Ulrich

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Publication Type

Wissenschaftlicher Artikel

Published in

Pediatric Radiology, 2024

Abstract

Background Idiopathic intracranial hypertension in children often presents with non-specific symptoms found in conditions such as hydrocephalus. For definite diagnosis, invasive intracranial pressure measurement is usually required. Ultrasound (US) of the optic nerve sheath diameter provides a non-invasive method to assess intracranial pressure. Transtemporal US allows imaging of the third ventricle and thus assessment for hydrocephalus. Objective To investigate whether the combination of US optic nerve sheath and third ventricle diameter can be used as a screening tool in pediatric idiopathic intracranial hypertension to indicate elevated intracranial pressure and exclude hydrocephalus as an underlying pathology. Further, to analyze whether both parameters can be used to monitor treatment outcome. Materials and methods We prospectively included 36 children with idiopathic intracranial hypertension and 32 controls. Using a 12-Mhz linear transducer and a 1–4-Mhz phased-array transducer, respectively, optic nerve sheath and third ventricle diameters were determined initially and during the course of treatment. Results In patients, the mean optic nerve sheath diameter was significantly larger (6.45±0.65 mm, controls: 4.96±0.32 mm) and the mean third ventricle diameter (1.69±0.65 mm, controls: 2.99±1.31 mm) was significantly smaller compared to the control group, P<0.001. Optimal cut-off values were 5.55 mm for the optic nerve sheath and 1.83 mm for the third ventricle diameter. Conclusions The combined use of US optic nerve sheath and third ventricle diameter is an ideal non-invasive screening tool in pediatric idiopathic intracranial hypertension to indicate elevated intracranial pressure while ruling out hydrocephalus. Treatment can effectively be monitored by repeated US, which also reliably indicates relapse.

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Faculties

Institutions

UKU. Klinik für diagnostische und interventionelle Radiologie

Citation

DFG Project uulm

EU Project THU

Other projects THU

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CC BY 4.0 International

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DOI external

DOI external

10.1007/s00247-024-05905-9

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DFG Project THU

item.page.thu.projectEU

item.page.thu.projectOther

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Keywords

Idiopathic intracranial hypertension, Non-invasive diagnosis, Optic nerve sheath diameter, Pediatric, Pseudotumor cerebri, Third ventricle diameter, Ultrasound, DDC 610 / Medicine & health