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Robert A. Avery, Daniel J. Licht, Samir S. Shah, Jimmy Huh, Jan Boswinkel, Michael D. Ruppe, Jeffrey A. Seiden, Rakesh D. Mistry, Grant T. Liu; Cerebrospinal Fluid Opening Pressure in Children with Optic Nerve Head Edema: A Case-Control Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3886.
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We previously reported that an abnormal cerebrospinal fluid (CSF) opening pressure (OP) in children was greater than 28 cm H2O. Since elevated intracranial pressure can cause optic nerve head edema (ONHE), we would expect that most patients with ONHE not due to infectious, inflammatory or ischemic conditions would have an OP greater than 28 cm H2O. This study describes the range of OP for children with ONHE not due to infectious, inflammatory or ischemic conditions and compared them to age-matched controls without ONHE.
Case subjects were children (1 - 18 years of age) enrolled in a prospective study of CSF OP that demonstrated ONHE at time of lumbar puncture and that the ONHE later resolved. Patients with ONHE secondary to infectious (e.g., Lyme disease), inflammatory (e.g., sarcoid) or ischemic (e.g., vasculitis) conditions were excluded. Control subjects from the same study, but without ONHE, were matched to cases based on age, depth of sedation during lumbar puncture, and body mass index category. The mean OP and distribution was compared between cases and controls.
Of the 472 subjects enrolled in the study, 41 OP measurements were obtained from 33 patients with ONHE who did not have any exclusionary criteria and matched to 41 control subjects without ONHE. Case subjects had a significantly higher OP (mean, 41.4 cm H20; range, 22-56) than control subjects (mean, 18.9 cm H2O; range, 9-29; paired t-test p < 0.01). Forty of 41 (97.6%) OP measurements from case subjects were ≥ 30 cm H2O, whereas none of the control subjects had OP measures ≥ 30 cm H2O.
Children with ONHE not related to infectious, inflammatory or ischemic causes typically have an OP ≥ 28 cm H2O, significantly higher than age-matched controls without ONHE. This study provides further support to our previously published findings that suggests an abnormal OP in children is typically above 28 cm H2O.
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