April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Cerebrospinal Fluid Opening Pressure in Children with Optic Nerve Head Edema: A Case-Control Study
Author Affiliations & Notes
  • Robert A. Avery
    Neurology, Children's National Medical Center, Washington, Dist. of Columbia
  • Daniel J. Licht
    Neurology,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Samir S. Shah
    Infectious Diseases,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Jimmy Huh
    Critical Care Medicine,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Jan Boswinkel
    Pediatrics,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Michael D. Ruppe
    Critical Care Medicine,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Jeffrey A. Seiden
    Emergency Medicine,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Rakesh D. Mistry
    Emergency Medicine,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Grant T. Liu
    Neuro-Ophthalmology Service,
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Footnotes
    Commercial Relationships  Robert A. Avery, None; Daniel J. Licht, None; Samir S. Shah, None; Jimmy Huh, None; Jan Boswinkel, None; Michael D. Ruppe, None; Jeffrey A. Seiden, None; Rakesh D. Mistry, None; Grant T. Liu, None
  • Footnotes
    Support  NIH 1T32NS061779-01
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 3886. doi:
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    • Get Citation

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

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Abstract

Purpose: : 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.

Methods: : 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.

Results: : 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.

Conclusions: : 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.

Keywords: optic nerve 
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