Non-Invasive Detection of Recurrent Intracranial Pressure via Optical Coherence Tomography: A Case Report

Area of Science:

• Ophthalmology
• Neurology
• Medical Imaging

Background:

• Papilledema is a common indicator of increased intracranial pressure (ICP).
• Detecting ICP relapse is challenging, especially with pre-existing optic nerve atrophy, as fundoscopy may not show re-swelling.
• Idiopathic hydrocephalus and ventriculoperitoneal shunt complications can lead to recurrent ICP.

Purpose of the Study:

• To report a case of recurrent increased intracranial pressure (ICP) in a patient with optic atrophy.
• To highlight the utility of optical coherence tomography (OCT) in detecting subtle signs of ICP recurrence.
• To emphasize OCT's role in monitoring treatment response when papilledema is not clinically evident.

Main Methods:

• Case report of a 23-year-old woman with a history of idiopathic hydrocephalus and ventriculoperitoneal shunt.
• Utilized optical coherence tomography (OCT) to assess peripapillary nerve fiber layer (pRNFL) swelling.
• Correlated OCT findings with clinical symptoms, neurological examination, fundus evaluation, MRI, and cerebrospinal fluid (CSF) pressure measurements via lumbar puncture.

Main Results:

• The patient presented with symptoms of increased ICP and pRNFL swelling on OCT, despite optic nerve pallor and absence of visible papilledema on fundoscopy.
• Magnetic resonance imaging (MRI) did not initially show signs of increased ICP.
• Following lumbar puncture and CSF removal, symptoms resolved, visual acuity improved, and pRNFL swelling decreased on OCT.

Conclusions:

• Optical coherence tomography (OCT) is a sensitive, non-invasive tool for detecting recurrent increased intracranial pressure (ICP).
• OCT can identify pRNFL swelling indicative of ICP even in the presence of optic atrophy and without visible papilledema.
• OCT is valuable for monitoring treatment efficacy in patients with suspected high ICP and optic atrophy.