Postural changes in optic nerve and optic nerve sheath diameters in postural orthostatic tachycardia syndrome and spontaneous intracranial hypotension: A cohort study

Autoři: Debora Cipriani aff001;  Belén Rodriguez aff001;  Levin Häni aff001;  Raya Zimmermann aff001;  Jens Fichtner aff001;  Christian T. Ulrich aff001;  Andreas Raabe aff001;  Jürgen Beck aff002;  Werner J. Z‘Graggen aff001
Působiště autorů: Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland aff001;  Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany aff002;  Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Postural orthostatic tachycardia syndrome is a disorder of the autonomic nervous system. Approximately 30% of patients experience orthostatic headaches. Orthostatic headaches also are a hallmark symptom in spontaneous intracranial hypotension. While the cause of orthostatic headaches in spontaneous intracranial hypotension can be linked to the cerebrospinal fluid loss at the spinal level and consecutively reduced intracranial pressure in the upright position, the cause of orthostatic headaches in postural orthostatic tachycardia syndrome still remains unknown. The present study examined orthostatic changes of intracranial pressure using dynamic ultrasound of the optic nerve and optic nerve sheath diameter in postural orthostatic tachycardia syndrome, spontaneous intracranial hypotension and healthy subjects.


Data was obtained from postural orthostatic tachycardia syndrome patients with (n = 7) and without orthostatic headaches (n = 7), spontaneous intracranial hypotension patients (n = 5) and healthy subjects (n = 8). All participants underwent high-resolution transorbital ultrasound in the supine and upright position to assess optic nerve and optic nerve sheath diameter.


Group differences were found in percentage deviations when changing position of optic nerve sheath diameter (p < 0.01), but not regarding the optic nerve diameter. Pairwise comparisons indicated differences in optic nerve sheath diameter only between spontaneous intracranial hypotension and the other groups. No differences were found between postural orthostatic tachycardia syndrome patients with and without orthostatic headaches.


This study shows that the size of the optic nerve sheath diameter dynamically decreases during orthostatic stress in spontaneous intracranial hypotension, but not in postural orthostatic tachycardia syndrome with or without orthostatic headaches, which indicates different underlying causes.

Klíčová slova:

Analysis of variance – Cerebrospinal fluid – Headaches – Magnetic resonance imaging – Optic nerve – Ultrasound imaging – Hypotension – Tachycardia


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2019 Číslo 10
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