Assessment of optic nerve sheath enlargement and Frisen classification in idiopathic intracranial hypertension - Implications for estimating intracranial pressure and grading chronic papilledema

Sep 30, 2026

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The study investigates the relationship between optic nerve sheath diameter (ONSD) measured by ultrasonography (USG) and cerebrospinal fluid (CSF) opening pressure in idiopathic intracranial hypertension (IIH). A prospective observational design enrolled 47 IIH patients. ONSD was assessed using USG, while opening CSF pressure was obtained via lumbar puncture (LP). Significant right-left ONSD association was found, but ONSD and opening pressure were not significantly correlated.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Purpose

Materials and Methods

Results

Conclusion

Introduction

Definition and diagnosis of IIH

Invasive vs noninvasive ICP measurement

Materials and Methods

Study design

| Access this article online | | --- | | Quick Response Code: | | | | Website:
[http://journals.lww.com/TJOP](http://journals.lww.com/TJOP) | | DOI:
10.4103/tjo.TJO-D-24-00082 | 1Department of Ophthalmology, Portsaid University, Departments of 2Anaesthesia and 3Neurosurgery, Faculty of Medicine, Portsaid University, Portsaid, 4Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, 5Department of Ophthalmology, Faculty of Medicine, Portsaid University, Portsaid, Egypt *Address for correspondence: Dr. Raghda Shawky El-Gendy, Department of Ophthalmology, Faculty of Medicine, Portsaid University, Portsaid, Egypt. E-mail: raghdashawki@ [med.psu.edu.eg](med.psu.edu.eg) Submission: 06-07-2024 Accepted: 02-12-2024 Published: 14-04-2025 Original Article Taiwan J Ophthalmol 2025;15:618-625 Assessment of optic nerve sheath enlargement and Frisen classification in idiopathic intracranial hypertension: Implications for estimating intracranial pressure and grading chronic papilledema Raghda Shawky El‑Gendy1*, Ahmad Shehata Abd ElHamid2, Ayman ElSayedAli Galhom3, NihalAdel Hassan4, Ehab Mahmoud Ghoneim5 | Abstract:
PURPOSE: This study aimed to investigate the correlation between ONSD measured by USG and opening cerebrospinal fluid (CSF) pressure in cases of IIH.
MATERIALS AND METHODS: This study employed a prospective observational design. It included 47 patients diagnosed with IIH. ONSD was measured using USG while opening CSF pressure was measured using LP. The study analyzed the correlation between ONSD, CSF opening pressure, and other variables.
RESULTS: The study discovered a significant positive association between the measurements of right and left ONSD. However, the ONSD and opening CSF pressure were not significantly correlated. The axial length showed a negative correlation with ONSD. The study determined that an ONSD cutoff value of 5.67 mm was optimal for the prediction of high ICP.
CONCLUSION: The investigation concluded that there is no significant relationship between ONSD distension and opening CSF pressure in IIH cases, suggesting that USG may not be reliable for estimating ICP. Frisen classification may have limited application in patients with chronic papilledema.
Keywords:
Cerebrospinal fluid pressure, idiopathic increased intracranial pressure, lumbar puncture, optic nervesheath diameter, papilledema, ultrasonography | | | --- | --- | | Introduction
Intracranial hypertension (IIH) is a common
cause of papilledema, particularly in obese women of childbearing age.[1] Before diagnosing IIH, other potential causes of elevated intracranial pressure (ICP), such as venous sinus thrombosis, metabolic or toxic reasons, and intracranial masses, should be ruled out using cranial magnetic resonance imaging (MRI) . An elevated cerebrospinal
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercialNoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
For reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](contact: WKHLRPMedknow_reprints@wolterskluwer.com) | fluid (CSF) opening pressure (>20 cm H2O) is used to confirm the diagnosis of IIH.[2] Various methods have been used to measure ICP and diagnose its elevation . Some methods are noninvasive, while others are invasive.[3] The most commonly used approach to evaluate ICP is diagnostic lumbar puncture (LP), although it is an invasive technique and carries the risk of complications such as hemorrhages and infections.[4,5]
How to cite this article: El-Gendy RS, ElHamid AS, GalhomAE, Hassan NA, Ghoneim EM. Assessment of optic nerve sheath enlargement and Frisen classification in idiopathic intracranial hypertension: Implication

FAQs

What was the primary purpose of the study?

To assess the correlation between ONSD measured by USG and CSF opening pressure in cases of IIH.

How were ONSD and CSF opening pressure measured?

ONSD was measured using ultrasonography, and opening CSF pressure was measured using lumbar puncture.

What did the study find about the usefulness of USG for estimating ICP?

ONSD and opening CSF pressure were not significantly correlated, suggesting USG may not be reliable for estimating intracranial pressure in IIH.

Sep 30, 2026

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