眼-颈一体超声在特发性颅内压增高及颅内静脉窦血栓中的应用价值

目的 研究眼部超声及颈静脉超声在特发性颅内压增高(ⅡH)及颅内静脉窦血栓(CVST)中的应用价值.方法 回顾性纳入2017年1月至2019年12月于吉林大学白求恩第一医院神经内科住院治疗的新诊断的IIH患者20例、CVST患者25例,所有的患者需完成眼部超声及颈部静脉超声检查.收集年龄、性别和BMI匹配的对照组40例....

The clinical value of eye-neck integrated ultrasound in idiopathic intracranial hypertension and cerebral venous sinus thrombosis

Objective The clinical presentation of cerebral venous sinus thrombosis(CVST)overlaps with that of idiopathic intracranial hypertension(IIH),but no screening tool exists.We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST.Methods Twenty IIH patients,25 CVST patients,and 40 healthy controls were retrospectively analyzed.The ultrasonographic optic nerve sheath diameter(ONSD)and hemodynamic characteristics of the internal jugular veins(IJVs)were recorded.The cerebrospinal fluid opening pressure was measured after ultrasonic examination.Results The ONSD was significantly larger in IIH patients than in controls(4.71±0.41 vs.3.93±0.24 mm,P<0.001).The ONSD cut-off for IIH diagnosis was 4.25 mm(AUC=0.978,95%CI 0.95~1.00,P<0.001,sensitivity:90%,specificity:93%).In the CVST group,19(76%)patients had elevated intracranial pressure(ICP);the mean ONSD was significantly higher in patients with increased ICP than in those without(4.35±0.22 vs.3.96±0.18 mm,P<0.001).The mean blood flow volume(BFV)was significantly reduced in CVST patients(404.43±314.73 mL/min)compared to that in controls(680.37±233.03 mL/min,P<0.001)and IIH patients(617.67±282.96 ml/min,P=0.008).The optimal BFV cut-off for predicting CVST was 471.60 ml/min(AUC=0.841,95%CI 0.73~0.95,P<0.001,sensitivity:88%,specificity:72%).No difference in frequency of IJVVI between patients and controls.Conclusion Eye-neck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs.ONSD measurement can identify patients with increased ICP,and reduced IJV BFV may aid the differentiation of CVST and IIH.