Quantitative Assessment of Optic Disc Elevation in Idiopathic Intracranial Hypertension
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- Category: Vol. 81, September 2013
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Quantitative Assessment of Optic Disc Elevation in Idiopathic Intracranial Hypertension, AHMAD M.M. SHALABY, MOHAMMAD A. NASR, NEVIN M. SHALABY, ASMAA M. EBRAHEIM and REHAM SHAMLOUL
Abstract
Introduction: Quantification of optic disc elevation in papilledema may predict CSF opening pressure.
Objective: To correlate height of papilledema in idiopathic intracranial hypertension (IIH) to cerebrospinal fluid (CSF) opening pressure and visual function and monitor its rate of resolution.
Design: Cross-sectional ecological study.
Patients and Methods: Twenty female patients with IIH with a mean age of 29.8±5.8 years and mean body mass index (BMI) of 37.3±5.5Kg/m2 underwent general and neuro-ophthalmological assessment, brain CT/MRI and magnetic resonance venography (MRV), visual field testing, lumbar puncture (LP) with measuring of CSF opening pressure, and optical coherence tomography (OCT) to measure degree of optic disc elevation at presentation, 3 and 7 days post LP and after 3 and 6 weeks, with clinical follow-up.
Results: Mean optic disc elevation from retinal surface to summit pre-LP was 469±216.5tim and mean CSF opening pressure was 364.17±93.85mmH20; they did not correlate with each other. Visual field losses and visual acuity (VA) did not correlate with optic disc height, but correlated positively with CSF opening pressure. The mean optic disc elevation was significantly lower 3 days post-LP and after 6 weeks from treatment compared to pre-LP. Repeated therapeutic LP showed a higher rate of resolution relative to acetazolamide alone.
Conclusion: The height of papilledema in IIH is not indicative of CSF opening pressure or visual function. OCT is a beneficial tool for monitoring resolution of papilledema and hence therapeutic efficacy through measuring disc height. Resolution of papilledema is attained within 6 weeks with proper therapeutic measures.