Abstract
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.