1. Retinal vessel dynamics analysis as a surrogate marker for raised intracranial pressure in patients with suspected idiopathic intracranial hypertension.
- Author
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Hagen, Snorre Malm, Wibroe, Elisabeth Arnberg, Korsbæk, Johanne Juhl, Andersen, Mikkel Schou, Nielsen, Asger Bjørnær, Nortvig, Mathias Just, Beier, Dagmar, Poulsen, Frantz Rom, Jensen, Rigmor Højland, and Hamann, Steffen
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INTRACRANIAL hypertension , *RETINAL blood vessels , *INTRACRANIAL pressure , *BIOMARKERS , *FLUID pressure - Abstract
Introduction: Retinal vessel dynamics analysis has proven to be a viable, non-invasive surrogate marker for increased intracranial pressure. We aimed to test this method in patients with suspected idiopathic intracranial hypertension. Methods: Patients with suspected idiopathic intracranial hypertension were prospectively enrolled for hand-held fundus-videography during diagnostic lumbar puncture. After extracting optic disc images, peripapillary arteriole-tovenule-ratios were measured using machine-learning algorithms with manual identification control. A general linear model was applied to arteriole-to-venule-ratios and corresponding lumbar opening pressures to estimate cerebrospinal fluid pressure. Results: Twenty-five patients were included with a significant difference in arteriole-to-venule-ratio between patients with (n=17) and without (n=8) idiopathic intracranial hypertension (0.78±0.10 vs 0.90±0.08, p=0.006). Arterioleto-venule-ratio correlated inversely with lumbar opening pressure (slope regression estimate -0.0043 (95% CI -0.0073 to -0.0023), p=0.002) and the association was stronger when lumbar opening pressure exceeded 15mmHg (20 cm H2O) (slope regression estimate -0.0080 (95% CI -0.0123 to -0.0039), p<0.001). Estimated cerebrospinal fluid pressure predicted increased lumbar opening pressure >20mmHg (27 cm H2O) with 78% sensitivity and 92% specificity (AUC 0.81, p=0.02). A stand-alone arteriole-to-venule-ratio measurement predicting lumbar opening pressure >20mmHg (27 cm H2O) was inferior with a 48% sensitivity and 92% specificity (AUC 0.73, p=0.002). Conclusion: Retinal vessel dynamics analysis with the described model for estimating cerebrospinal fluid pressure is a promising non-invasive method with a high sensitivity and specificity for detecting elevated intracranial pressure at follow-up assessments of patients with confirmed idiopathic intracranial hypertension if initial lumbar opening pressure and arteriole-to-venule-ratio data are available. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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