Non-invasive intracranial pressure monitoring in idiopathic intracranial hypertension and lumbar puncture in pediatric patient: Case report

Abstract

Background: Intracranial pressure (ICP) monitoring has been variously explored as a diagnostic and therapeutic modality in many pathological conditions leading neurological injury. This monitoring standardly depends on an invasive procedure such as cranial or lumbar catheterization. The gold standard for ICP monitoring is through an intraventricular catheter, but this invasive technique is associated with certain risks such as haemorrhage and infection. (1) Also, it is a high-cost procedure and consequently not available in a variety of underprivileged places and clinical situations in which intracranial hypertension is prevalent (3). An accurate non-invasive and low-priced method to measure elevated ICP would therefore be desirable. Under these circumstances, Brazilian scientists developed a non-invasive method for intracranial pressure monitoring (ICP-NI), which uses an electric resistance extensometer that measures micro deformations of the skull and transforms it into an electrical signal. In this case report, the authors describe a pediatrician patient with the diagnosis of idiopathic intracranial hypertension who was successfully submitted to a lumbar puncture under monitorization with this device.

Case description: 7 year old girl with progressive symptoms that lead to the diagnosis of idiopathic intracranial hypertension. The patient was submitted to a lumbar punction with continuous non-invasive ICP monitoring.

Conclusion: Estimating ICP (non-invasive) from LP monitoring (invasive) often reflect inaccurate ICP results, and affects negatively on IIH diagnosis and a non-invasive diagnostic method could reduce the requirement for invasive approaches, improving patient health outcomes.

Keywords: Idiopathic intracranial hypertension; Intracranial pressure; Intracranial pressure monitoring; Lumbar puncture.

Figure 1:

(1.1) Shows P1, P2, P3 normal wave form, (1.2) represent the association of Langfitt curve and the wave form changes whatever the wave form change the format. (1.3) show how to measure the non-invasive method.

Figure 2:

Show the evolution of the wave form, (2.1) 30 min before punction represent P2/P1 wiht 1.10, representing high pressure, (2.2) represent an little bit higher during the procedure, (2.3) nevertheless after 60 min the punction pression get better, showing, that the noninvasive method might help in decision-making.