title: Diagnostic value of the optic nerve sheath diameter in pseudotumor cerebri.
abstract: If persistent severe headache remains the only complaint of a patient, then the diagnosis of pseudotumor cerebri (PTC) can be delayed because in such cases practitioners are hesitant to immediately apply invasive intracranial pressure (ICP) measurement. Our purpose was to apply the technique of measuring diameters of the optic nerve sheath (ONSD) as a diagnostic tool in cases of PTC. Our aim was to provide practitioners with an additional sign to speed up their decision making about implementation of the lumbar puncture. In a retrospective study, CT scan data of 35 consecutive adult patients with PTC were collected and analyzed. ONSD were measured at the point where the ophthalmic artery crosses the optic nerve (anatomical landmark). The correlation analysis was performed with sex, age, and neuro-ophthalmological findings. We found that the ONSD was enlarged in 94.3% of patients with PTC. The enlarged ONSD were 6.2±1.2mm for the right and 6.3±0.9mm for the left (cut-off value >5.5mm). The enlargement was bilateral, and no correlation with age or sex was found (p=0.67 and p=0.76, respectively). Presence of papilledema was detected in 91.4% of patients (32/35) presenting as a slightly less valuable diagnostic sign compared with ONSD. We conclude that in the majority of cases of PTC the ONSD is significantly enlarged, indicating elevated ICP even if CT scans are negative. Implementing this ONSD method as a diagnostic tool in cases of suspected PTC may help in early accurate diagnosis, avoiding misdiagnosis, and providing appropriate early treatment.
authors.affiliation: Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Inessa
authors.initials: I
authors.lastname: Bekerman
authors.affiliation: Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Sigal
authors.affiliation: Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kimiagar
authors.affiliation: Department of Ophthalmology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Zina Evy
authors.initials: ZE
authors.lastname: Almer
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 33 Shapiro Street, Bat Yam 59561, Israel. Electronic address: vaimed@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011559:Pseudotumor Cerebri / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*; D055815:Young Adult
keywords: Computed tomography; Optic nerve sheath diameter; Pseudotumor cerebri