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August 1978

Venous Pulsations Not Always Indicative of Normal Intracranial Pressure

Author Affiliations

Dept Neurology Memorial Sloan-Kettering Cancer Center 1275 York Ave New York, NY 10021 Dept Neurology Cornell University Med Col New York, NY 10021

Arch Neurol. 1978;35(8):550. doi:10.1001/archneur.1978.00500320070022

To the Editor.—  In the January 1978 issue of the Archives (35:37-40, 1978), Levin states that the "... presence of spontaneous [central retinal] venous pulsations [prior to lumbar puncture] is a reliable indicator of an intracranial pressure below 180 to 190 mm H2O...." Our experience suggests that exceptions to his findings occur and may not be rare.Recently, within a one-month period at Memorial Hospital, New York, we found elevated intracranial pressure (ICP) in four patients who were noted to have spontaneous central retinal venous pulsations (VPs) by direct ophthalmoscopic examination in both the sitting and recumbent positions before lumbar puncture (LP). Ophthalmoscopy disclosed otherwise normal fundi. The presence of VPs was also noted during LP in the left lateral decubitus position simultaneously with the measurement of elevated ICP. None of the conditions of the patients showed evidence of acute change in neurologic status before or after LP. In