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Elevated lumbar puncture opening pressure in aseptic meningitis

  • Meital Ben-Dov
    Correspondence
    Corresponding author at: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel.
    Affiliations
    Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Avi Fellner
    Affiliations
    Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Ophir Keret
    Affiliations
    Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Itay Lotan
    Affiliations
    Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Lilach Goldstein
    Affiliations
    Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    EEG and Epilepsy Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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  • Daphna Mezad-Koursh
    Affiliations
    Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Israel Steiner
    Affiliations
    Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Ainat Klein
    Affiliations
    Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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      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 H2O 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 H2O (SD = 6.02) as opposed to the mean normal LPOP (NLPOP) of 16.13 cm H2O (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).

      Keywords

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