eprintid: 10049819 rev_number: 62 eprint_status: archive userid: 608 dir: disk0/10/04/98/19 datestamp: 2018-06-11 11:35:38 lastmod: 2021-10-04 00:22:13 status_changed: 2019-06-24 16:27:18 type: article metadata_visibility: show creators_name: Funnell, JP creators_name: Craven, CL creators_name: D'Antona, L creators_name: Thompson, SD creators_name: Chari, A creators_name: Thorne, L creators_name: Watkins, LD creators_name: Toma, AK title: Intracranial pressure in patients with papilloedema ispublished: pub subjects: UCH divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F82 divisions: F85 keywords: cerebrospinal fluid, headache, hydrocephalus, neuroophthalmology, vision and ocular movements note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: OBJECTIVES: Papilloedema is a clinical manifestation of chronically raised intracranial pressure (ICP), often seen in idiopathic intracranial hypertension (IIH). However, the extent of intracranial hypertension required to produce papilloedema is not known. We compare ICP values in IIH patients who developed papilloedema and those who did not. We aim to identify a pathological ICP threshold predictive of the development of papilloedema in IIH patients. MATERIALS AND METHODS: Single-centre cohort of IIH patients (2006-2016) who underwent 24-hour ICP monitoring (ICPM) and ophthalmology assessments, prior to intervention. Papilloedema was graded according to the Frisén scale. An unpaired t-test compared 24-hour ICPM between papilloedema and no-papilloedema groups. Fisher's exact test was used to determine predictive value of ICP. RESULTS: Thirty-six patients with IIH (35 F: 1M), mean age 32.5 ± 9.49 years (mean ± SD) were included. Patients with papilloedema had a mean median 24-hour ICP of 10.4 ± 5.32 mm Hg (n = 25), significantly higher than the group without papilloedema 6.31 ± 3.30 mm Hg (n = 11) (P < .05). The papilloedema group were exposed to higher pressures (10 mm Hg) for 30 minutes or more. Using 24-hour median ICP of 10 mm Hg as a minimum cut-off predictive value gives a specificity = 91%, sensitivity = 48%, PPV = 92% and NPV = 44% of detecting papilloedema. CONCLUSIONS: A 24-hour ICP of 10 mmHg or more is a good predictor for papilloedema and reflects a pathological threshold. The range varied widely suggesting papilloedema can occur at even lower pressures. These results are consistent with emerging evidence suggest that pathologically "high" 24 hours ICP is lower than previously quoted. date: 2018-08 date_type: published official_url: https://doi.org/10.1111/ane.12922 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1542538 doi: 10.1111/ane.12922 language_elements: English lyricists_name: D'Antona, Linda lyricists_name: Toma, Ahmed lyricists_name: Watkins, Laurence lyricists_id: LDANT12 lyricists_id: ATOMA88 lyricists_id: LDWAT79 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: Acta Neurologica Scandinavica volume: 138 number: 2 pagerange: 137-142 event_location: Denmark issn: 1600-0404 citation: Funnell, JP; Craven, CL; D'Antona, L; Thompson, SD; Chari, A; Thorne, L; Watkins, LD; Funnell, JP; Craven, CL; D'Antona, L; Thompson, SD; Chari, A; Thorne, L; Watkins, LD; Toma, AK; - view fewer <#> (2018) Intracranial pressure in patients with papilloedema. Acta Neurologica Scandinavica , 138 (2) pp. 137-142. 10.1111/ane.12922 <https://doi.org/10.1111/ane.12922>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10049819/1/Funnell_ICP_papillodema_version_3_.pdf document_url: https://discovery.ucl.ac.uk/id/eprint/10049819/7/Funnell_Figure%201%20%281%29.pdf document_url: https://discovery.ucl.ac.uk/id/eprint/10049819/13/Funnell_Figure%202.pdf document_url: https://discovery.ucl.ac.uk/id/eprint/10049819/20/Funnell_Figure%203.pdf