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. 2019 Oct 9;14(10):e0223484.
doi: 10.1371/journal.pone.0223484. eCollection 2019.

Postural changes in optic nerve and optic nerve sheath diameters in postural orthostatic tachycardia syndrome and spontaneous intracranial hypotension: A cohort study

Debora Cipriani  1   2 , Belén Rodriguez  1 , Levin Häni  1 , Raya Zimmermann  1 , Jens Fichtner  1 , Christian T Ulrich  1 , Andreas Raabe  1 , Jürgen Beck  2 , Werner J Z'Graggen  1   3
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Free PMC article

Postural changes in optic nerve and optic nerve sheath diameters in postural orthostatic tachycardia syndrome and spontaneous intracranial hypotension: A cohort study

Debora Cipriani et al. PLoS One. .
Free PMC article

Abstract

Background: Postural orthostatic tachycardia syndrome is a disorder of the autonomic nervous system. Approximately 30% of patients experience orthostatic headaches. Orthostatic headaches also are a hallmark symptom in spontaneous intracranial hypotension. While the cause of orthostatic headaches in spontaneous intracranial hypotension can be linked to the cerebrospinal fluid loss at the spinal level and consecutively reduced intracranial pressure in the upright position, the cause of orthostatic headaches in postural orthostatic tachycardia syndrome still remains unknown. The present study examined orthostatic changes of intracranial pressure using dynamic ultrasound of the optic nerve and optic nerve sheath diameter in postural orthostatic tachycardia syndrome, spontaneous intracranial hypotension and healthy subjects.

Methods: Data was obtained from postural orthostatic tachycardia syndrome patients with (n = 7) and without orthostatic headaches (n = 7), spontaneous intracranial hypotension patients (n = 5) and healthy subjects (n = 8). All participants underwent high-resolution transorbital ultrasound in the supine and upright position to assess optic nerve and optic nerve sheath diameter.

Results: Group differences were found in percentage deviations when changing position of optic nerve sheath diameter (p < 0.01), but not regarding the optic nerve diameter. Pairwise comparisons indicated differences in optic nerve sheath diameter only between spontaneous intracranial hypotension and the other groups. No differences were found between postural orthostatic tachycardia syndrome patients with and without orthostatic headaches.

Conclusion: This study shows that the size of the optic nerve sheath diameter dynamically decreases during orthostatic stress in spontaneous intracranial hypotension, but not in postural orthostatic tachycardia syndrome with or without orthostatic headaches, which indicates different underlying causes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
A: Illustration of the human eyeball and optic nerve. B: Magnification of the optic nerve and its compartments: The dashed arrow indicates the diameter of the optic nerve, the continuous arrow the diameter of the optic nerve sheath and the stars the perineural space. C: High-resolution transorbital ultrasound image of the optic nerve complex. The diameters of the optic nerve (dashed arrow) and optic nerve sheath (continuous arrow) were measured 3 mm behind the papilla (dotted line).
Fig 2
Fig 2. Bar graphs showing diameter changes (supine to standing) of A) the optic nerve sheath, B) optic nerve and C) perineural space.
Values are given as means ± S.E.M. * p ≤ 0.05; ** p ≤ 0.01. POTS, postural orthostatic tachycardia syndrome; OSH, orthostatic headache; SIH, spontaneous intracranial hypotension.
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The authors received no specific funding for this work.