بررسی قطر غلاف عصب اپتیک در مقایسه با فشار مایع مغزی نخاعی در کودکان افزایش فشار داخل مغزی ایدیوپاتیک

زمینه و هدف: مطالعه حاضر با هدف تشخیص غیرتهاجمی افزایش فشار مایع مغزی نخاعی در بیماران دارای افزایش فشار داخل مغزی ایدیوپاتیک با کمک سونوگرافی ترانس اوربیتال صورت گرفته است.روش بررسی: دراین مطالعه توصیفی -مقطعی تمام بیماران زیر 18 سال که با شکایت افزایش سر درد یا استفراغ یا تاری دید یا فلج عصب شش به درمانگاه نورولوژی بیمارستان لقمان حکیم تهران از مهر ماه سال 96 تا مهر ماه سال 97 مراجعه نموده‌اند‌، مورد مطالعه قرار گرفتند. همه بیمارانی که در معاینه ادم پاپی داشتند و تصویربرداری مغزی آن‌ها نرمال بود و مشکوک به افزایش فشار داخل مغزی ایدیوپاتیک‌ بودند به‌صورت متوالی وارد مطالعه شدند. برای هر بیمار پیش از انجام پونکسیون کمری، قطر غلاف عصب اپتیک با سونوگرافی ترانس اوربیتال اندازه‌گیری شد و سپس‌ پونکسیون کمری جهت بررسی فشار مایع مغزی نخاعی انجام شد.یافته‌ها: از 10 بیمار مطالعه حاضر 10% دختر، 90% پسر، با حداقل سنی 2.5 سال، حداکثر 14 سال، میانگین سنی نه سال و متوسط توده بدنی kg/m2 22.5 بوده‌اند. تمام مراجعین فشار مایع مغزی نخاعی بیشتر از 25 (متوسط cm 40 آب) و همگی اندازه قطر غلاف عصب اپتیک چشم راست و چپ در آن‌ها بیشتر از نقطه برش mm 4.5 (با میانگین در چشم راست mm 6.31 و چشم چپ mm 6.64 بوده است.نتیجه‌گیری: با توجه به یافته‌های مطالعه حاضر اندازه‌گیری قطر غلاف عصب اپتیک در بیماران مشکوک به افزایش فشار داخل مغزی ایدیوپاتیک می‌تواند به‌عنوان روش کمک تشخیصی غیرتهاجمی مطرح شود.

Evaluation of optic nerve sheath diameter in comparison with cerebrospinal fluid pressure in children with idiopathic intracranial hypertension.

Background: The purpose of this study is a noninvasive diagnosis of increasing the pressure of cerebrospinal fluid in patients involved in idiopathic intracranial hypertension (IIH) that is done with transbulbar sonography.Methods: In this descriptive crosssectional study all the nontoxic children under 18 who were referred to the neurology clinic of Loghman Hospital of Tehran from October 2017 to October 2018 with increased intracerebral pressure symptoms were studied. The increased intracerebral pressure symptoms were headache or vomiting or blurred vision or 6th nerve palsy and they had papillary edema. Also, if their diagnostic brain imaging measures were normal such as: Magnetic Resonance Imaging (MRI), Computed Tomography scan (CT scan) and in some cases Magnetic Resonance Venography (MRV), they were suspected to Idiopathic intracranial hypertension and were entered into the study consecutively. Their complete medical history and comorbidities and biographical information were recorded in the file. All patients were candidates for a lumbar puncture to measure cerebrospinal fluid pressure. After full explanation to the parents and obtaining written consent from them before performing a lumbar puncture, patients in coordination with the ultrasound unit without delay in performing a lumbar puncture, first underwent trans orbital ultrasound in supine position and were awakened with closed eyes. Opticians were implanted in both eyes by a skilled sonographer. And then sedated with sedatives (ketamine or midazolam) prescribed by an anesthesiologist. It was placed in a sterile position in a supine semiflexion position and with lateral decubitus aligned with the body. Cerebrospinal fluid pressure to cm of water was recorded using a serum set in the lumber intervertebral space 45. Then a sample was sent for analysis and smear.Results: Out of 10 patients (age 2.5 -14 year, mean 9 years) 10% were girls, 90% were boys, and mean BMI was 22.5 kg/m2. Their symptoms included: 80% Headache, 40% Vomiting, 40% Diplopia, 20% Blurred vision, 10% 6th nerve palsy, and 10% Tinnitus when being reffered. In All patients, CSF pressure was more than 25 cm H2o (mean 40 cm H2o), right and left eyes optic nerve sheath diameter (ONSD) was more than the cutoff point (ONSD le;4.5 mm), the mean right ONSD was 6.31 mm and left eye was 6.64 mm.Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non -invasive diagnosis method.