Beruflich Dokumente
Kultur Dokumente
High-resolution ultra-
sound evaluation of internal jugular venous valves. Eur Radiol No Correlation between
1999;9:1222–1226.
10. Akkawi NM, Agosti C, Rozzini L, et al. Transient global am- Intraocular Pressure and
nesia and venous flow patterns. Lancet 2001;357:639.
11. Maalikjy Akkawi N, Agosti C, Anzola GP, et al. Transient Intracranial Pressure
global amnesia: a clinical and sonographic study. Eur Neurol
2003;49:67–71. Ying Han, MD, PhD,1 Timothy J. McCulley, MD,1
12. Ishikawa M. Clinical guidelines for idiopathic normal pressure and Jonathan C. Horton, MD, PhD1,2
hydrocephalus. Neurol Med Chir (Tokyo) 2004;44:222–223.
13. Relkin N, Marmarou A, Klinge P, et al. Diagnosing idiopathic
normal-pressure hydrocephalus. Neurosurgery 2005;57(3 A recent study has reported an excellent correlation between
suppl):S4 –S16. intraocular pressure (IOP) and intracranial pressure (ICP),
14. Marmarou A, Bergsneider M, Klinge P, et al. The value of sup- suggesting that measurement of IOP may serve as a nonin-
plemental prognostic tests for the preoperative assessment of id- vasive means to determine ICP. To reexamine the relation
iopathic normal-pressure hydrocephalus. Neurosurgery 2005;
between IOP and ICP, we reviewed the medical records of
57(3 suppl):S17–S28.
15. Akkawi NM, Agosti C, Borroni B, et al. Jugular valve all patients who underwent lumbar puncture between 1991
incompetence: a study using air contrast ultrasonography on a and 2007 in the neuro-ophthalmology clinic at the Univer-
general population. J Ultrasound Med 2002;21:747–751. sity of California San Francisco. Data for IOP and ICP were
16. Malm J, Eklund A. Idiopathic normal pressure hydrocephalus. available for 55 patients. There was no correlation between
Pract Neurol 2006;6:14 –27. IOP and ICP (Pearson correlation coefficient, r ⫽ 0.07; p ⫽
17. Welch K, Friedman V. The cerebrospinal fluid valves. Brain 0.59). IOP measurement is not a useful substitute for ICP
1960;83:454 – 469. measurement.
18. Di Chiro G. Observations on the circulation of the cerebrospi-
nal fluid. Acta Radiol Diagn (Stockh) 1966;5:988 –1002. Ann Neurol 2008;64:221–224
19. Greitz D. Cerebrospinal fluid circulation and associated intracra-
nial dynamics. A radiologic investigation using MR imaging and
radionuclide cisternography. Acta Radiol Suppl 1993;386:1–23.
An accurate noninvasive way to measure intracranial
20. Zmajevic M, Klarica M, Varda R, et al. Elimination of phenol-
sulfonphthalein from the cerebrospinal fluid via capillaries in pressure (ICP) has long been sought, with little success.
central nervous system in cats by active transport. Neurosci Lett If intraocular pressure (IOP) were a faithful reflection
2002;321:123–125. of ICP, it would offer an easy solution. In rhesus mon-
keys, an increase in IOP has been reported after exper-
imental increase of ICP.1 In this study, however, IOP
rarely increased to more than the reference range, lead-
ing the authors to predict that the value of isolated
IOP measurements would be limited, if applied to the
evaluation of patients with intracranial hypertension.
In another macaque study, IOP and ICP were varied
by manipulation of PaCO2.2 Again, IOP remained
within the reference range, even at the maximum re-
corded ICP. In a human study, a correlation was found
between ICP and IOP with repeated measurements in
single patients, but no consistent relation prevailed
from patient to patient.3 Another study found a corre-
lation across patients, but concluded that “enough vari-
ability. . . exists to preclude using IOP to precisely de-
Stimuli
Experimental methods have been described in detail in a
prior report.8 Subjects sat in a chair on a Moog
From the 1Neurology Service and Daroff-Dell’Osso Laboratory, 6DOF2000E electric motion platform (Moog, East Aurora,
Veterans Affairs Medical Center; and Departments of 2Neurology
and 3Biomedical Engineering, Case Western Reserve University, NY). Belts were used to secure the subject’s torso, and a
Cleveland, OH. snugly fitting skate-board helmet, inlaid with foam, stabilized
Received Jan 10, 2008, and in revised form Mar 6, 2008. Accepted the subject’s head. Any head movements that were decoupled
for publication Mar 28, 2008. from chair or platform motion were measured, as described
later. The tVOR stimulus consisted of 2Hz bob (typical am-
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/ana.21407 plitude ⫾ 2.3cm), and the rVOR stimulus was 1Hz yaw
(typical amplitude ⫾ 6 degrees), each for a duration of 12
Address correspondence to Dr Walker, Department of Neurology,
Case Western Reserve University, Cleveland VAMC, 10701 seconds. In one patient (P8), only bob stimuli were applied.
East Boulevard, 127-W, Cleveland, OH 44106. Data from two visual conditions, each used for one exper-
E-mail: mark.walker@case.edu imental run, are presented here: (1) subjects binocularly