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Elevated lumbar puncture opening pressure in aseptic meningitis.

Meital Ben-Dov1, Avi Fellner2, Ophir Keret3

  • 1Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|October 20, 2022
PubMed
Summary

Elevated lumbar puncture opening pressure (ELPOP) occurs in 14% of aseptic meningitis patients and is linked to higher BMI. Lumbar puncture opening pressure measurement is crucial for all aseptic meningitis cases.

Keywords:
Aseptic meningitisCerebrospinal fluid opening pressureIntracranial pressureLumbar puncture opening pressureObesitySwollen discs

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Elevated lumbar puncture opening pressure (ELPOP) is an understudied phenomenon in aseptic meningitis.
  • Characterizing ELPOP features is essential for understanding its implications in aseptic meningitis.

Purpose of the Study:

  • To investigate the prevalence and clinical features of ELPOP in patients diagnosed with aseptic meningitis.
  • To identify potential associations between ELPOP and patient demographics, clinical findings, and cerebrospinal fluid (CSF) parameters.

Main Methods:

  • An observational, retrospective, single-center study included 116 adult patients with aseptic meningitis or meningoencephalitis.
  • Lumbar puncture opening pressure (LP OP) was measured, with ELPOP defined as >25 cm H2O.
  • Demographic data, clinical information, CSF analysis, and optic disc appearance were analyzed.

Main Results:

  • 16 patients (14%) presented with ELPOP, averaging 32.4 years old.
  • The ELPOP group had a significantly higher Body Mass Index (BMI) (p=0.0081).
  • Optic disc swelling was observed in 40% of ELPOP patients versus 3.2% in normal LPOP patients; CSF content showed no significant differences.

Conclusions:

  • This study highlights the frequency of ELPOP in aseptic meningitis and its association with increased BMI.
  • Measuring LP OP in all aseptic meningitis patients is recommended.
  • Further research is needed to establish the threshold for tolerated intracranial pressure (ICP).