Hemodynamic profiles in idiopathic intracranial hypertension: Doppler ultrasonography as a diagnostic tool for pulsatile tinnitus

Year 2024, Volume: 49 Issue: 3, 793 - 800, 30.09.2024

Dilek Ağırcan , Mehmet Demir

https://doi.org/10.17826/cumj.1521231

Abstract

Purpose: This study aims to evaluate the role of ophthalmic Doppler ultrasonography (USG) in differentiating IIH patients with and without bilateral PT by analyzing hemodynamic changes in the orbital vessels.
Materials and Methods: A prospective, single-center, case-control study was conducted at Harran University from November 2023 to June 2024. The study included 20 IIH patients. Participants underwent clinical assessments, ophthalmic evaluations, brain imaging, lumbar puncture, and transorbital sonography. IIH patients were categorized into PT (n=8) and non-PT (n=12) groups. Doppler USG measured end-diastolic velocity (EDV), peak systolic velocity (PSV), time-averaged velocity (TAV), resistive index (RI), pulsatility index (PI), and systolic to the diastolic ratio (S/D) of the central retinal artery.
Results: Significant differences were observed in left eye EDV and TAV, with lower values in the PT group. Although not statistically significant, right-eye EDV and TAV also trended lower in the PT group. Additionally, both eyes' PSV values showed a trend toward statistical significance, being lower in the PT group. ROC curve analysis identified optimal thresholds for left eye EDV (5.35; sensitivity 75%, specificity 83.33%) and TAV (9; sensitivity 50%, specificity 91.67%).
Conclusion: Orbital Doppler USG reveals distinct hemodynamic profiles in IIH patients with PT, suggesting EDV and TAV as potential biomarkers. Larger cohort studies are needed to validate and clarify IIH-PT mechanisms.

Keywords

Pseudotumor Cerebri, Pulsatile Tinnitus, Central Retinal Artery, Transorbital Sonography, Flow Velocities

Ethical Statement

The study was approved by the local ethics committee of Harran University Medical Faculty in 2023 (Protocol number: HRU/23.21.19).

Supporting Institution

None

Thanks

None

İdiyopatik intrakraniyal hipertansiyonda hemodinamik profiller: pulsatil tinnitus için tanısal bir araç olarak Doppler ultrasonografi

Abstract

Amaç: Bu çalışmada orbital damarlardaki hemodinamik değişiklikleri analiz ederek bilateral PT olan ve olmayan IIH hastalarını ayırt etmede oftalmik Doppler ultrasonografinin (USG) rolü değerlendirildi.
Gereç ve Yöntem: Kasım 2023 - Haziran 2024 tarihleri arasında Harran Üniversitesi'nde prospektif, tek merkezli, vaka-kontrol çalışması yapıldı. Çalışmaya 20 IIH hastası dahil edildi. Katılımcılara klinik değerlendirmeler, oftalmik değerlendirmeler, beyin görüntüleme, lomber ponksiyon ve transorbital sonografi uygulandı. IIH hastaları PT (n=8) ve PT olmayan (n=12) gruplar olarak kategorize edilmiştir. Doppler USG ile end-diyastolik hız (EDV), pik sistolik hız (PSV), zaman ortalamalı hız (TAV), rezistif indeks (RI), pulsatilite indeksi (PI) ve santral retinal arterin sistolik/diyastolik oranı (S/D) ölçüldü.
Bulgular: Sol göz EDV ve TAV değerlerinde PT grubunda daha düşük olmak üzere anlamlı farklılıklar gözlendi. İstatistiksel olarak anlamlı olmamakla birlikte, sağ göz EDV ve TAV değerleri de PT grubunda daha düşük olma eğilimindeydi. Ayrıca, her iki gözün PSV değerleri PT grubunda daha düşük olmak üzere istatistiksel anlamlılığa doğru bir eğilim göstermiştir. ROC eğrisi analizi sol göz EDV (5,35; duyarlılık %75, özgüllük %83,33) ve TAV (9; duyarlılık %50, özgüllük %91,67) için optimal eşikleri belirlemiştir.
Sonuç: Orbital Doppler USG, PT'li IIH hastalarında farklı hemodinamik profiller ortaya koyarak EDV ve TAV'ın potansiyel biyobelirteçler olduğunu düşündürmektedir. IIH-PT mekanizmalarını doğrulamak ve açıklığa kavuşturmak için daha büyük kohort çalışmalarına ihtiyaç vardır.

Keywords

Psödotümör Serebri, Pulsatil Tinnitus, Santral Retinal Arter, Transorbital Sonografi, Akım Hızları

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