Raised intracranial pressure: retinal vein pulsation ruled it out

Clinical bottom line (level 4)

  1. Patients with spontaneous retinal vein pulsation were much less likely to have raised intracranial pressure.
  2. Absence of retinal vein pulsation increased the risk of raised intracranial pressure but further tests were required (LR+8.1) .
Levin : Archives of Neurology 1978; 35: 37-40
Expires October 2003

The study

Setting: Veteran Affairs hospital, USA

189 patients (aged 20 to 90, ~52% male) : normal individuals compared with patients with papilloedema, intracranial mass lesions or raised intracranial pressure

Excluded if
  • known glaucoma
  • poorly seen fundi



    • Independent unblinded reference standard, applied in some patients from a ?consecutive inappropriate spectrum.
    Reference standard:
    • Any of
      • lumbar puncture or radiology
      • follow-up if absent retinal vein pulsation
    Diagnostic test: retinal vein pulsation on ophthalmology: slow narrowing and more rapid dilation of segment overlying the optic disk

    The evidence


    diagnostic test raised intracranial pressure normal intracranial pressure LR+
    (95% CI)    		 LR-
    (95% CI)
    Absence of retinal vein pulsation 43 18 8.1
    (5.3 to 13)     		0.0
    (0.0 to 0.080)
    total 43 146

    Comments

    1. There are doubts about this being a consecutive series of patients, and the spectrum of patients chosen.
    2. Post-test probabilities are meaningless in an pre-selected group.

    Citation

    1. Levin BE, : the clinical significance of spontaneous pulsations of the retinal vein. Archives of Neurology 1978; 35: 37-40
    Contributor: David Sackett and Chris Ball, October 1999
    Reviewer: Malcolm Daniel

    Clinical Question.
    Patient suspected raised intracranial pressure
    Intervention or Exposure absence of retinal vein pulsation
    Outcome raised intracranial pressure