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Abstract
Objective: To assess prospectively the accuracy and precision of a method for noninvasive intracranial pressure (ICP) measurement compared with invasive gold standard CSF pressure measurement.
Methods: Included were 62 neurologic patients (37 idiopathic intracranial hypertension, 20 multiple sclerosis, 1 Guillain-Barré syndrome, 1 polyneuropathy, and 3 hydrocephalus). The average age was 40 ± 12 years. All patients had lumbar puncture indicated as a diagnostic procedure. ICP was measured using a noninvasive ICP measurement method, which is based on a two-depth high-resolution transcranial Doppler insonation of the ophthalmic artery (OA). The OA is being used as a natural pair of scales, in which the intracranial segment of the OA is compressed by ICP and the extracranial segment of the OA is compressed by extracranial pressure (Pe) applied to the orbit. The blood flow parameters in both OA segments are approximately the same in the scales balance case when Pe = ICP. All patients had simultaneous recording of noninvasive ICP values and invasive gold standard CSF pressure values.
Results: Analysis of the 72 simultaneous paired recordings of noninvasive ICP and the gold standard CSF pressure showed good accuracy for the noninvasive method as indicated by the low mean systematic error (0.12 mm Hg; confidence level [CL] 0.98). The method also showed high precision as indicated by the low SD of the paired recordings (2.19 mm Hg; CL 0.98). The method does not need calibration.
Conclusion: The proposed noninvasive ICP measurement method is precise and accurate compared with gold standard CSF pressure measured via lumbar puncture.
GLOSSARY
- ABP=
- arterial blood pressure;
- CL=
- confidence level;
- ICP=
- intracranial pressure;
- IOA=
- intracranial segment of the internal ophthalmic artery;
- MS=
- multiple sclerosis;
- nICP=
- noninvasive intracranial pressure;
- OA=
- ophthalmic artery;
- TBI=
- traumatic brain injury;
- TCD=
- transcranial Doppler
Footnotes
Study funding: Supported in part by the European Commission under the 7th Framework Programme projects BrainSafe (grant agreement no. 232545) and TBIcare (grant agreement no. 270259).
Supplemental data at www.neurology.org
- Received September 6, 2011.
- Accepted January 25, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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Letters: Rapid online correspondence
- Response to Miller et al.
- Response Liebeskind et al.
- Blood flow velocities are reduced in the optic nerve with elevated intracranial pressure
- Pressure On The Orbit Does Not Balance Transmural Pressure In The Segments Of Ophthalmic Artery
- A noninvasive intracranial pressure absolute value measurement method: promising in understanding hyper-perfusion syndrome
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