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Laura L Scott, Shawn Aylward, David Rogers, Rachel E Reem; Correlation of opening pressure and Frisén grade of papilledema in pediatric patients with intracranial hypertension. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2231.
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While clinicians are diagnosing idiopathic and secondary intracranial hypertension in pediatric patients with increasing frequency, a paucity of research regarding the diagnosis and clinical features of these conditions exists. We performed a retrospective chart review of pediatric patients with intracranial hypertension in order to examine the relationship between lumbar puncture opening pressure (LPOP) and the severity of papilledema grade utilizing the Modified Frisén Scale (MFS).
130 patients presenting between 2007 and 2013 with lumbar puncture-confirmed intracranial hypertension were included in the study. Demographic data and exam findings from initial exam with an ophthalmologist were collected. The worse papilledema grade between the two eyes on initial exam was compared to LPOP using Spearman’s Rank Correlation Coefficient, “r.” A second reader rated the subjects’ fundus photos and the inter-rater reliability was calculated using Cohen’s chance-corrected kappa statistic, “k.”
Of the 130 included patients, 78 were female and 52 were male. The mean age of patients evaluated was 12.3 years old (range 3-18). 39 subjects were diagnosed with secondary intracranial hypertension. Seventy four patients had their lumbar puncture performed on the same day as their eye exam. A statistically significant moderately positive correlation was found between LPOP and Frisén grade of papilledema (r=0.426, p-value=0.000153). Even including those whose LP and eye exam were performed on different days, there was a weakly positive correlation between the LPOP and papilledema grade (r=0.255, p-value of 0.003371). In addition, 236 optic disc photos of 119 patients were reviewed. The linear weighted kappa value indicating inter-rater reliability indicated a good strength of agreement (k=0.669).
In pediatric patients with intracranial hypertension, the severity of papilledema correlates positively with lumbar puncture opening pressure. This result confirms the findings of a recent study in adult patients1 and may be helpful in guiding the clinical management of patients afflicted with intracranial hypertension.<br /> <br /> References<br /> 1. Kupersmith M. Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial: Part II. Correlations and Relationship to Clinical Features. Investigative ophthalmology & visual science. 2014-11-04.
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