Association of Intracranial Pressure and Spontaneous Retinal Venous Pulsation

Question  Is infrared video assessment of spontaneous venous pulsation useful for identifying patients with elevated intracranial pressure?

Findings  In this study that included 105 patients, there was a statistically significant association between the grading of spontaneous venous pulsation (assessed through infrared videos) and simultaneous intracranial pressure in patients without papilledema.

Meaning  Infrared video assessments of spontaneous venous pulsation can be used as a noninvasive method of assessment of intracranial pressure and have the potential to help determine which patients need invasive intracranial pressure monitoring.

Importance  A convenient and reliable method for noninvasive intracranial pressure assessments is desirable to reduce the need for invasive procedures (eg, intracranial pressure monitoring and lumbar punctures) and allow clinicians to identify and treat patients with intracranial hypertension in a timely manner.

Objective  To determine whether infrared video assessment of spontaneous retinal venous pulsation is associated with intracranial pressure and is a valid tool to indicate the presence or absence of raised intracranial pressure in patients without papilledema.

Design, Setting, and Participants  A single-center prospective study was conducted at a tertiary referral center between January 2017 and May 2018. Patients consecutively admitted for clinically indicated elective 24-hour invasive intracranial pressure monitoring had ophthalmic review including infrared video recording of their spontaneous venous pulsation. Two neuro-ophthalmologists, who were masked to the intracranial pressure monitoring results, independently graded the spontaneous venous pulsation (grade 0 to 3). Analysis began in June 2018.

Main Outcomes and Measures  The association between simultaneously recorded intracranial pressure and spontaneous venous pulsation (binary variable: present/absent) assessed through retinal infrared video recordings was evaluated using a multiple linear regression model.

Results  Of 105 patients, the mean (SD) age was 39 (14) years, and 79 (75%) were women. The mean (SD) simultaneous intracranial pressure was 1 (5) mm Hg for 91 patients (86.7%) with spontaneous venous pulsations and 13 (14) mm Hg for 14 patients (13.3%) without spontaneous venous pulsations. A multiple linear regression model adjusted for 7 potential confounders confirmed a statistically significant association between intracranial pressure and spontaneous venous pulsation (β = −9.1; 95% CI, −13.7 to −4.6; P < .001; adjusted R² = 0.42).

Conclusions and Relevance  The absence of spontaneous venous pulsation on retinal infrared video recordings is significantly associated with higher levels of intracranial pressure and should raise the suspicion of intracranial hypertension.