Neuropediatrics 2014; 45(04): 206-211
DOI: 10.1055/s-0034-1376202
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Reference Range of Cerebrospinal Fluid Opening Pressure in Children: Historical Overview and Current Data

Robert A. Avery
1   Department of Neurology, Children's National Medical Center, Washington, District of Columbia, United States
› Author Affiliations
Further Information

Publication History

16 August 2013

03 March 2014

Publication Date:
27 May 2014 (online)

Abstract

The lumbar puncture and cerebrospinal fluid (CSF) opening pressure (OP) in children remains an essential diagnostic test for children with suspected elevated intracranial pressure. Recent prospective data have revised the normative CSF OP values and described how clinical variables such as age, depth of sedation, and obesity may influence the measurements. In addition, the new normative data are now reflected in revised diagnostic criteria for idiopathic intracranial hypertension/pseudotumor cerebri syndrome. This review highlights the recently published data and provides guidance on how it may impact clinical management.

 
  • References

  • 1 Quincke H. Ueber Hydrocephalus. Verh Congresses Inn Med 1891; 10: 321-340
  • 2 Welch K. The intracranial pressure in infants. J Neurosurg 1980; 52 (5) 693-699
  • 3 Rangwala LM, Liu GT. Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 2007; 52 (6) 597-617
  • 4 Ellis III R. Lumbar cerebrospinal fluid opening pressure measured in a flexed lateral decubitus position in children. Pediatrics 1994; 93 (4) 622-623
  • 5 Whiteley W, Al-Shahi R, Warlow CP, Zeidler M, Lueck CJ. CSF opening pressure: reference interval and the effect of body mass index. Neurology 2006; 67 (9) 1690-1691
  • 6 Avery RA, Shah SS, Licht DJ , et al. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 2010; 363 (9) 891-893
  • 7 Lee MW, Vedanarayanan VV. Cerebrospinal fluid opening pressure in children: experience in a controlled setting. Pediatr Neurol 2011; 45 (4) 238-240
  • 8 Gallagher A, Pike M, Berg S. Beware CSF pressure measured under general anaesthesia. Arch Dis Child 2004; 89 (7) 691
  • 9 Lim MJ, Lin J-P. The effects of carbon dioxide on measuring cerebral spinal fluid pressure. Childs Nerv Syst 2009; 25 (7) 783-784
  • 10 Eidlitz-Markus T, Stiebel-Kalish H, Rubin Y, Shuper A. CSF pressure measurement during anesthesia: an unreliable technique. Paediatr Anaesth 2005; 15 (12) 1078-1082
  • 11 Ben Yehuda Y, Watemberg N. Ketamine increases opening cerebrospinal pressure in children undergoing lumbar puncture. J Child Neurol 2006; 21 (6) 441-443
  • 12 Talke P, Caldwell JE, Richardson CA. Sevoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. Anesthesiology 1999; 91 (1) 127-130
  • 13 Michalczyk K, Sullivan JE, Berkenbosch JW. Pretreatment with midazolam blunts the rise in intracranial pressure associated with ketamine sedation for lumbar puncture in children. Pediatr Crit Care Med 2013; 14 (3) e149-e155
  • 14 Corbett JJ, Mehta MP. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology 1983; 33 (10) 1386-1388
  • 15 Neville L, Egan RA. Frequency and amplitude of elevation of cerebrospinal fluid resting pressure by the Valsalva maneuver. Can J Ophthalmol 2005; 40 (6) 775-777
  • 16 Abbrescia KL, Brabson TA, Dalsey WC , et al; Lumbar Puncture Study Group. The effect of lower-extremity position on cerebrospinal fluid pressures. Acad Emerg Med 2001; 8 (1) 8-12
  • 17 Avery RA, Mistry RD, Shah SS , et al. Patient position during lumbar puncture has no meaningful effect on cerebrospinal fluid opening pressure in children. J Child Neurol 2010; 25 (5) 616-619
  • 18 Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 2004; 75 (6) 813-821
  • 19 Avery RA, Licht DJ, Shah SS , et al. CSF opening pressure in children with optic nerve head edema. Neurology 2011; 76 (19) 1658-1661
  • 20 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81 (13) 1159-1165
  • 21 Rossiter JD, Lockwood AJ, Evans AR. Coexistence of optic disc drusen and idiopathic intracranial hypertension in a child. Eye (Lond) 2005; 19 (2) 234-235