Elevated lumbar puncture opening pressure in aseptic meningitis. (December 2022)

• Record Type: Journal Article
• Authors: Ben-Dov, Meital; Fellner, Avi; Keret, Ophir; Lotan, Itay; Goldstein, Lilach; Mezad-Koursh, Daphna; Steiner, Israel; Klein, Ainat
• Is Part Of: Journal of clinical neuroscience. Volume 106(2022)
• Page Start: 55
• Page End: 60
• Publication Date: 2022-12
• Subjects: Aseptic meningitis -- Intracranial pressure -- Cerebrospinal fluid opening pressure -- Lumbar puncture opening pressure -- Swollen discs -- Obesity; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.10.001
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: High BMI may play a key role in the pathogenesis of increased intracranial pressure (IICP) in aseptic meningitis. IICP may be manifested in the absence of classical signs and symptoms, such as transient visual obscuration, tinnitus, diplopia, or positional headache. IICP can occur in the absence of optic disc edema. Brain and orbit imaging must be taken in cases of swollen discs with or without IICP/elevated lumbar puncture opening pressure (ELPOP). LP OP should be measured in every lumbar puncture performed in patients with aseptic meningitis since increased pressure is not rare. Abstract: Objectives: Elevated lumbar puncture opening pressure (ELPOP) is a reported but understudied phenomenon in aseptic meningitis. This study aimed to characterize the features of ELPOP in aseptic meningitis patients. Methods: An observational, retrospective, single-center study was conducted. We included all adult patients diagnosed with aseptic meningitis or meningoencephalitis from October 2015 to May 2017, for whom lumbar puncture opening pressure (LP OP) was measured. OP > 25 cm H2 O was documented as ELPOP. Patients' demographic characteristics, clinical data, laboratory and cerebrospinal fluid (CSF) results, as well as optic disc appearance were analyzed. Results: Among 116 patients (61 males) included, 16 patients (14 %) had ELPOP (11 males). The average age of those patients was 32.4 years (SD = 9.8), and the mean OP was 31.7 cm H2 O (SD = 6.02) as opposed to the mean normal LPOP (NLPOP) of 16.13 cm H2 O (SD = 4.15). Body mass index (BMI) was significantly higher in the ELPOP group (p = 0.0081). Funduscopic examination was documented in 15/16 patients in the ELPOP group and revealed swollen optic discs in 6 (40 %) patients. Fundus examination was performed in 62 patients in the NLPOP group, of whom 2 (3.2 %) had a swollen disc. There was no difference in CSF content between groups. Conclusions: This study fills the void of information lacking on the frequency of ELPOP in aseptic meningitis. Its association with increased BMI may be related to the pathogenesis. LP OP should be measured in all patients with aseptic meningitis. Additional research is needed to determine the threshold of tolerated intracranial pressure (ICP).