June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Investigating the Cerebrospinal Fluid Pressure Waveform and Volume Pressure Response in Idiopathic Intracranial Hypertension
Author Affiliations & Notes
  • Monica D Okon
    Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
  • Cynthia J Roberts
    Ophthalmology & Visual Science, The Ohio State University, Columbus, Ohio, United States
    Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
  • Ashraf M Mahmoud
    Ophthalmology & Visual Science, The Ohio State University, Columbus, Ohio, United States
    Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
  • Andrew N Springer
    Anesthesiology, The Ohio State University, Columbus, Ohio, United States
  • Robert H Small
    Anesthesiology, The Ohio State University, Columbus, Ohio, United States
    Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
  • John M. McGregor
    Neurosurgery, The Ohio State University, Columbus, Ohio, United States
  • Steven E. Katz
    Ophthalmology & Visual Science, The Ohio State University, Columbus, Ohio, United States
  • Footnotes
    Commercial Relationships   Monica Okon, None; Cynthia Roberts, Oculus (C), Optimeyes (C), Ziemer (C); Ashraf Mahmoud, None; Andrew Springer, None; Robert Small, Spouse - Oculus (C), Spouse - Optimeyes (C), Spouse - Ziemer (C); John McGregor, None; Steven Katz, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4304. doi:
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      Monica D Okon, Cynthia J Roberts, Ashraf M Mahmoud, Andrew N Springer, Robert H Small, John M. McGregor, Steven E. Katz; Investigating the Cerebrospinal Fluid Pressure Waveform and Volume Pressure Response in Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4304.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To characterize tissue compliance and the cerebrospinal fluid (CSF) pressure waveform in idiopathic intracranial hypertension (IIH).

Methods : Twelve subjects who met the Modified Dandy Criteria, including papilledema and visual field loss, received an ultrasound guided lumbar puncture (LP) where CSF pressure (CSFP) was recorded at each increment of CSF removal. CSF pressure at each increment of volume removed was plotted (Figure 1) and used to calculate tissue compliance for each subject. Six subjects had their CSFP waveform recorded with an electronic transducer. BMI, mean CSFP, and cerebral perfusion pressure (CPP) were also calculated.

Results : For all subjects, the average opening and closing CSFP was 32.58 ± 6.04 mmHg (Range: 20 to 42 mmHg) and 13.43 ± 2.53 mmHg (Range: 10 to 17 mmHg) respectively. Nine of the subjects had an average initial and final CPP of 50.60 ± 13.51 mmHg (Range: 30 to 69 mmHg) and 105 ± 10.82 mmHg (Range: 90 to 127 mmHg) respectively. Six of the subjects had an average initial and final Cerebral Pulse Amplitude (CPA) of 6.81 ± 2.01 mmHg (Range: 4.37 to 9.64 mmHg) and 1.28 ± .46 mmHg (Range: .79 to 1.79 mmHg) respectively. CSFP, CPA, and CPP were found to be significantly different (p < .05) before and after the LP. CSFP and CPA decreased after the LP, while CPP increased. The cerebrospinal tissue compliance significantly increased (P < .05) post-LP, with decreased CSFP. CPA and CSFP were significantly positively correlated (Figure 2).

Conclusions : Both low cerebrospinal tissue compliance (at high CSFP) and high cerebrospinal tissue compliance (at low CSFP) regions were determined for each subject. The CSFP waveform in IIH was characterized as a function of volume, and CPA was found to be influenced by the magnitude of CSFP and cerebrospinal tissue compliance. Future studies will investigate how cerebrospinal tissue compliance may correlate to the symptoms and response to therapy in IIH subjects.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Figure 1: Pressure-Volume curve demonstrating the calculation of two elastance (inverse of compliance) regions for one subject

Figure 1: Pressure-Volume curve demonstrating the calculation of two elastance (inverse of compliance) regions for one subject

 

Figure 2: Cerebrospinal fluid pressure pulse amplitude with respect to the mean cerebrospinal fluid pressure

Figure 2: Cerebrospinal fluid pressure pulse amplitude with respect to the mean cerebrospinal fluid pressure

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