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Elevated cerebrospinal fluid opening pressure in a pediatric demyelinating disease cohort
Sona Narula1, Grant T Liu2, Robert A Avery3
1Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Elevated cerebrospinal fluid opening pressure is common in children with inflammatory demyelinating disease. Clinical and imaging findings did not explain this elevated pressure in pediatric patients.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
Background:
- Cerebrospinal fluid opening pressure (CSFP) is elevated in CNS infections and vasculitis.
- CSFP has not been previously evaluated in pediatric inflammatory demyelinating diseases (IDDs).
Purpose of the Study:
- To determine if children with IDDs exhibit elevated CSFP.
- To identify potential clinical and radiologic factors associated with elevated CSFP in pediatric IDDs.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with acute disseminated encephalomyelitis, multiple sclerosis, or clinically isolated syndromes.
- Comparison of CSFP measurements with a healthy pediatric cohort.
- Regression analyses to assess associations between CSFP and clinical/radiologic variables.
Main Results:
- Elevated CSFP was observed in 28% of pediatric patients with IDDs, significantly higher than controls (P=0.001).
- No correlation was found between elevated CSFP and the evaluated clinical or radiologic parameters.
Conclusions:
- A significant proportion of children with IDDs present with elevated CSFP.
- Current clinical and radiologic data do not explain the elevated CSFP in these pediatric patients.
- Further investigation into cerebrospinal fluid dynamics may be necessary to understand this finding.
Background:
Cerebrospinal fluid opening pressure is elevated with central nervous system infection and vasculitis, but has not been studied in inflammatory demyelinating disease. This retrospective study sought to determine whether children with demyelinating disease demonstrate elevated cerebrospinal fluid opening pressure, and to explore possible clinical and radiologic correlates.
Methods:
Pediatric patients with acute disseminated encephalomyelitis, multiple sclerosis, or a clinically isolated syndrome (including optic neuritis and transverse myelitis) who had a lumbar puncture within 1 month of presentation were eligible for inclusion, and were compared with a reference cohort of healthy children from the same institution. Regression analyses were used to determine the association of variables collected with opening pressure.
Results:
Opening pressure was elevated in 15 of 53 (28%) children, which was significantly higher than the reference cohort (P = 0.001). There was no relationship between elevated opening pressure and any of the clinical or radiologic variables collected.
Conclusion:
Although almost one third of children with inflammatory demyelinating disease have an elevated cerebrospinal fluid opening pressure, the clinical and radiologic variables evaluated in this study did not explain this finding, and further understanding may require assessment of cerebrospinal fluid flow dynamics.
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