Increased Intracranial Pressure in Acute Disseminated Encephalomyelitis

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Rotem Orbach1,2, Nira Schneebaum Sender3, Ronit Lubetzky1,2

  • 11 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Journal of Child Neurology
|November 28, 2018
PubMed

Insights

Elevated cerebrospinal fluid opening pressure is common in pediatric acute disseminated encephalomyelitis, suggesting increased intracranial pressure plays a role in this condition and may require monitoring.

Area of Science:

  • Pediatric Neurology
  • Neuroinflammation
  • Cerebrospinal Fluid Dynamics

Background:

  • Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory demyelinating disease of the central nervous system.
  • Intracranial pressure (ICP) monitoring is crucial for managing neurological conditions, but cerebrospinal fluid (CSF) opening pressure is often overlooked in ADEM.
  • Understanding ICP dynamics in ADEM can inform diagnosis and treatment strategies.

Purpose of the Study:

  • To evaluate the significance of CSF opening pressure in pediatric patients diagnosed with ADEM.
  • To determine the frequency and magnitude of elevated CSF opening pressure in ADEM.
  • To explore the potential implications of CSF opening pressure measurements in ADEM management.

Main Methods:

  • Retrospective chart review of pediatric patients with ADEM.
  • Inclusion of demographic, clinical, and laboratory data, with a focus on CSF opening pressure.
  • Analysis of CSF opening pressure in relation to other CSF parameters and established normal ranges.

Main Results:

  • Of 36 ADEM patients, 24 had documented CSF opening pressure.
  • Mean CSF opening pressure was 27.6±12.6 cmH2O, significantly higher than the normal upper limit of 18 cmH2O (P = .0013).
  • Elevated CSF opening pressure (>28 cmH2O) was observed in 42% of patients, making it the most frequent abnormal CSF finding.

Conclusions:

  • Increased CSF opening pressure is a common finding in pediatric ADEM.
  • Elevated ICP may be implicated in the pathophysiology of ADEM.
  • Routine measurement of CSF opening pressure could offer valuable monitoring and therapeutic insights in ADEM cases.
Abstract

Keywords:
acute disseminated encephalomyelitiscerebrospinal fluidintracranial pressureopening pressurespinal tapsteroids treatment

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