title: Elevated cerebrospinal fluid opening pressure in a pediatric demyelinating disease cohort.
abstract: BACKGROUND
  Cerebrospinal fluid opening pressure is elevated with central nervous system infection and vasculitis, but has not been studied in inflammatory demyelinating disease. This retrospective study sought to determine whether children with demyelinating disease demonstrate elevated cerebrospinal fluid opening pressure, and to explore possible clinical and radiologic correlates.
  
  
  METHODS
  Pediatric patients with acute disseminated encephalomyelitis, multiple sclerosis, or a clinically isolated syndrome (including optic neuritis and transverse myelitis) who had a lumbar puncture within 1 month of presentation were eligible for inclusion, and were compared with a reference cohort of healthy children from the same institution. Regression analyses were used to determine the association of variables collected with opening pressure.
  
  
  RESULTS
  Opening pressure was elevated in 15 of 53 (28%) children, which was significantly higher than the reference cohort (P = 0.001). There was no relationship between elevated opening pressure and any of the clinical or radiologic variables collected.
  
  
  CONCLUSIONS
  Although almost one third of children with inflammatory demyelinating disease have an elevated cerebrospinal fluid opening pressure, the clinical and radiologic variables evaluated in this study did not explain this finding, and further understanding may require assessment of cerebrospinal fluid flow dynamics.
authors: Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: narulas@email.chop.edu.
authors: Sona
authors: S
authors: Narula
authors: Division of Neuro-ophthalmology Service, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Grant T
authors: GT
authors: Liu
authors: Division of Neurology, Children's National Medical Center, Washington, DC.
authors: Robert A
authors: RA
authors: Avery
authors: Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Brenda
authors: B
authors: Banwell
authors: Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Amy T
authors: AT
authors: Waldman
mesh_terms: D015170:Cerebrospinal Fluid Pressure; D002648:Child; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D013129:Spinal Puncture
keywords: acute disseminated encephalomyelitis; demyelinating disease; intracranial pressure; lumbar puncture; multiple sclerosis; opening pressure; pediatric