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matthew zhang, Matthew Hollar, Noel Tulipan, Sean Donahue; Correlation between Optic Disc Examination, Symptoms and findings of Intracranial Pressure (ICP) Monitoring for Pediatric Patients and its Clinical Implications. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4128.
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This project investigates whether optic disc edema and symptoms of increased ICP (e.g. headache or visual obscurations) correlate with the findings of ICP monitoring in a pediatric population. We predict that findings of ICP monitoring correlate with both disc edema and symptoms.
A retrospective chart review was performed of Vanderbilt Children’s Hospital records for patients under 19 years old who underwent 24-hour continuous ICP monitoring with an intraparenchymal Codman ICP monitoring system between 1998 and 2014, and in whom at least 1 year of ophthalmology follow-up was available. 25 patients met entry criteria. Patients were categorized based upon the presence of symptoms suggestive of elevated ICP and disc appearance.
None of the 25 patients who underwent continuous intraparenchymal ICP monitoring developed complications from the procedure. Of 8 patients with symptoms but a normal disc on exam, only two patients had elevated ICP; of 9 patients with symptoms and disc edema, 8 had elevated ICP; 3 patients had symptoms with disc atrophy, of which only 1 patient had elevated ICP; 5 patients were asymptomatic with suspected pseudo-disc edema, and all 5 had normal ICP. To evaluate this categorical data, a Chi Squared test was used (p<0.0014). In each patient with elevated ICP, intervention with ventriculoperitoneal shunt followed monitoring.<br /> Patients with disc edema compared to patients with normal discs showed a trend toward elevated ICP which was not statistically significant (p=0.2043). The presence of symptoms among patients with disc edema was highly correlated with elevated ICP, and conversely, asymptomatic patients with suspected pseudo-disc edema were highly correlated with normal ICP (p=0.0030). The two-tailed Fisher’s exact test was used to draw statistical comparisons between groups of this study.
In asymptomatic patients with suspected pseudo-disc edema, ICP monitoring has the ability to potentially differentiate true disc edema from pseudo-disc edema based upon symptoms. ICP monitoring may also be helpful in determining actual ICP symptomatic patients with a normal disc exam. This study provides important correlates in guiding decision making for when to initiate ICP monitoring in the pediatric population in the setting of suspected elevated intracranial pressure.
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