Clin Exp OphthalmolNovember 201920 citations

Cerebrospinal fluid and optic nerve sheath compartment syndrome: A common pathophysiological mechanism in five different cases?

Hao Jie, Pircher Achmed, Miller Neil R, Hsieh Jiemei, Remonda Luca, Killer Hanspeter E

AI Summary

This study found optic nerve sheath compartmentation, impairing CSF flow, consistently linked to optic nerve dysfunction across varied conditions, suggesting a common mechanism for vision loss.

Abstract

Importance

Optic nerve (ON) dysfunction is a common feature of different diseases. The pathophysiology is not yet fully understood.

Background

This study describes five patients with ON sheath (ONS) compartment syndrome (ONSCS) and contributes to the hypothesis that impaired cerebrospinal fluid (CSF) flow can play a role in the development of ON dysfunction.

Design

Retrospective case series.

Participants

Five patients with ONSCS were included in the study.

Methods

Elaboration of medical histories and clinical and diagnostic findings over a long time period was carried out by analysing medical records and by a detailed medical consultation.

Main outcome measures

The main outcome measures include clinical history; visual acuity; field, intraocular and CSF pressures; and contrast-loaded computed tomographic (CT) cisternography.

Results

Compartmentation of the ONS demonstrated by contrast-loaded CT cisternography was the consistent finding in all five patients who demonstrated findings of ON dysfunction. The aetiologies varied and included meningitis, papilloedema, sphenoid wing meningioma, disc herniation and normal-tension glaucoma.

Conclusion and relevance: Compartmentation of the ONS with consecutively impaired CSF dynamics within the ON subarachnoid space can lead to ON dysfunction. Different aetiologies can cause the development of ONSCS.

MeSH Terms

AgedCerebrospinal FluidCerebrospinal Fluid PressureCompartment SyndromesFemaleHumansIntraocular PressureMaleMiddle AgedOptic Nerve DiseasesRetrospective StudiesTomography, X-Ray ComputedVisual AcuityVisual Fields

Shields Classification

Ch. 4Optic Nerve, Retina, and Choroid

Ch. 5Assessment of Visual Fields

Ch. 11Chronic Open-Angle Glaucoma and Normal Tension Glaucoma

Key Concepts4

Compartmentation of the optic nerve sheath (ONS) with consecutively impaired cerebrospinal fluid (CSF) dynamics within the optic nerve subarachnoid space can lead to optic nerve dysfunction.

MechanismCase seriesRetrospective case seriesn=Five patientsCh5

Different etiologies, including meningitis, papilledema, sphenoid wing meningioma, disc herniation, and normal-tension glaucoma, can cause the development of optic nerve sheath compartment syndrome (ONSCS).

MechanismCase seriesRetrospective case seriesn=Five patientsCh5Ch12

Compartmentation of the optic nerve sheath (ONS) demonstrated by contrast-loaded CT cisternography was a consistent finding in all five patients with optic nerve sheath compartment syndrome (ONSCS) who demonstrated findings of optic nerve dysfunction.

DiagnosisCase seriesRetrospective case seriesn=Five patientsCh5

This study describes five patients with optic nerve sheath (ONS) compartment syndrome (ONSCS) and contributes to the hypothesis that impaired cerebrospinal fluid (CSF) flow can play a role in the development of optic nerve dysfunction.