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Published in: Acta Neurochirurgica 1/2012

01-01-2012 | Clinical Article

Flash visual evoked potentials are unreliable as markers of ICP due to high variability in normal subjects

Authors: Linnea Andersson, Johanna Sjölund, Josefin Nilsson

Published in: Acta Neurochirurgica | Issue 1/2012

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Abstract

Background

Previous publications have suggested a high correlation between flash visual evoked potential (F-VEP) N2 peak latency and intracranial pressure. This would enable F-VEP to be used as a non-invasive and inexpensive method to estimate ICP in a number of settings. However, basic knowledge about variability across subjects and test-retest properties of the F-VEP is lacking.

Methods

Fifteen healthy adult subjects were tested on three different occasions. F-VEP responses were recorded using international standards.

Findings

For the tested population, mean N2 latency was 65.7 ms (SD 10.7 ms) and the range was 48–110 ms. Intra-individual variability was high, in four of the 15 subjects more than 15 ms between testing sessions. The same was found for P2 latency and for N2 and P2 amplitudes. The response waveform was very variable and unambiguous marking of peaks was often diffucult. One out of the 15 subjects had a very poorly developed F-VEP response, but a normal pattern-reversal VEP response.

Conclusions

F-VEP has a wide range of latency, amplitude and waveform across normal subjects. A large proportion of subjects also had a high intra-individual variability over time. This variability makes F-VEPs unreliable as a marker for intracranial pressure, and caution in interpreting F-VEP changes in clinical work is advised.
Literature
1.
go back to reference Carrai R, Grippo A, Lori S, Pinto F, Amantini A (2010) Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review. Intensive Care Med 36(7):1112–1126PubMedCrossRef Carrai R, Grippo A, Lori S, Pinto F, Amantini A (2010) Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review. Intensive Care Med 36(7):1112–1126PubMedCrossRef
2.
go back to reference Connolly MB, Jan JE, Cochrane DD (1991) Rapid recovery from cortical visual impairment following correction of prolonged shunt malfunction in congenital hydrocephalus. Arch Neurol 48(9):956–957PubMedCrossRef Connolly MB, Jan JE, Cochrane DD (1991) Rapid recovery from cortical visual impairment following correction of prolonged shunt malfunction in congenital hydrocephalus. Arch Neurol 48(9):956–957PubMedCrossRef
3.
go back to reference Constantini S, Umansky F, Nesher R, Shalit M (1987) Transient blindness following intracranial pressure changes in a hydrocephalic child with a V-P shunt. Childs Nerv Syst 3(6):379–381PubMedCrossRef Constantini S, Umansky F, Nesher R, Shalit M (1987) Transient blindness following intracranial pressure changes in a hydrocephalic child with a V-P shunt. Childs Nerv Syst 3(6):379–381PubMedCrossRef
4.
go back to reference Coupland SG, Cochrane DD (1987) Visual evoked potentials, intracranial pressure and ventricular size in hydrocephalus. Doc Ophtalmol 66:321–330CrossRef Coupland SG, Cochrane DD (1987) Visual evoked potentials, intracranial pressure and ventricular size in hydrocephalus. Doc Ophtalmol 66:321–330CrossRef
5.
go back to reference Davenport A, Bramley PN (1993) Cerebral function analysing monitor and visual evoked potentials as a noninvasive method of detecting cerebral dysfunction in patients with acute hepatic and renal failure treated with intermittent machine hemofiltration. Ren Fail 15(4):515–522PubMedCrossRef Davenport A, Bramley PN (1993) Cerebral function analysing monitor and visual evoked potentials as a noninvasive method of detecting cerebral dysfunction in patients with acute hepatic and renal failure treated with intermittent machine hemofiltration. Ren Fail 15(4):515–522PubMedCrossRef
6.
go back to reference Desch LW (2001) Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus. Dev Med Child Neurol 43:113–117PubMedCrossRef Desch LW (2001) Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus. Dev Med Child Neurol 43:113–117PubMedCrossRef
7.
go back to reference Gumerlock MK, York D, Durkis D (1994) Visual evoked responses as a monitor of itracranial pressure during hyperosmolar blood-brain barrier disruption. Acta Neurochir Suppl (Wein) 60:132–135 Gumerlock MK, York D, Durkis D (1994) Visual evoked responses as a monitor of itracranial pressure during hyperosmolar blood-brain barrier disruption. Acta Neurochir Suppl (Wein) 60:132–135
8.
go back to reference Liasis A, Thompson DA, Hayward R, Nischal KK (2003) Sustained raised intracranial pressure implicated only by pattern reversal visual evoked potentials after cranial vault expansion surgery. Pediatr Neurosurg 39:75–80PubMedCrossRef Liasis A, Thompson DA, Hayward R, Nischal KK (2003) Sustained raised intracranial pressure implicated only by pattern reversal visual evoked potentials after cranial vault expansion surgery. Pediatr Neurosurg 39:75–80PubMedCrossRef
9.
go back to reference Lin JS, Liu JHK (2010) Circadian variations in intracranial pressure and translaminar pressure difference in Sprague-Dawley Rats. Invest Ophthalmol Vis Sci 51(11):5739–5743PubMedCrossRef Lin JS, Liu JHK (2010) Circadian variations in intracranial pressure and translaminar pressure difference in Sprague-Dawley Rats. Invest Ophthalmol Vis Sci 51(11):5739–5743PubMedCrossRef
10.
go back to reference Nilsson J (2006) Intraindividual variability of flash-VEP latency over time in normal subjects. Clin Neurophys 117(Suppl 1):166CrossRef Nilsson J (2006) Intraindividual variability of flash-VEP latency over time in normal subjects. Clin Neurophys 117(Suppl 1):166CrossRef
11.
go back to reference Odom JV, Bach M, Brigell M, Holder GE, McCulloch DL, Tormene AP, Vaegan (2010) ISCEV standard for clinical visual evoked potentials (2009 update). Doc Ophthalmol 120:111–119PubMedCrossRef Odom JV, Bach M, Brigell M, Holder GE, McCulloch DL, Tormene AP, Vaegan (2010) ISCEV standard for clinical visual evoked potentials (2009 update). Doc Ophthalmol 120:111–119PubMedCrossRef
12.
go back to reference Rizzo PA, Pierelli F, Pozzessere G, Sancesario G, Boatta M, Santarcangelo G (1984) Pattern visual evoked potentials in pseudotumor cerebri. Acta Neurol 84:57–63 Rizzo PA, Pierelli F, Pozzessere G, Sancesario G, Boatta M, Santarcangelo G (1984) Pattern visual evoked potentials in pseudotumor cerebri. Acta Neurol 84:57–63
13.
go back to reference Rothstein TL (2000) The role of evoked potentials in anoxic-ischemic coma and severe brain trauma. J Clin Neurophysiol 17(5):486–497PubMedCrossRef Rothstein TL (2000) The role of evoked potentials in anoxic-ischemic coma and severe brain trauma. J Clin Neurophysiol 17(5):486–497PubMedCrossRef
14.
go back to reference Sarnthein J, Andersson M, Zimmermann MB, Zumsteg D (2009) High test-retest reliability of checkerboard reversal visual evoked potentials (VEP) over 8 months. Clin Neurophys 120:1835–1840CrossRef Sarnthein J, Andersson M, Zimmermann MB, Zumsteg D (2009) High test-retest reliability of checkerboard reversal visual evoked potentials (VEP) over 8 months. Clin Neurophys 120:1835–1840CrossRef
15.
go back to reference Soelberg Sörensen P, Trojaborg W, Gjerris F, Krogsaa B (1985) Visual evoked potentials in pseudotumor cerebri. Arch Neurol 42:150–153CrossRef Soelberg Sörensen P, Trojaborg W, Gjerris F, Krogsaa B (1985) Visual evoked potentials in pseudotumor cerebri. Arch Neurol 42:150–153CrossRef
16.
go back to reference Sjöström A, Uvebrant P, Roos A (1995) The light-flash-evoked response as a possible indicator of increased intracranial pressure in hydrocephalus. Childs Nerv Syst 11(7):381–387, discussion 387PubMedCrossRef Sjöström A, Uvebrant P, Roos A (1995) The light-flash-evoked response as a possible indicator of increased intracranial pressure in hydrocephalus. Childs Nerv Syst 11(7):381–387, discussion 387PubMedCrossRef
17.
go back to reference Stolz G, Aschoff JC, Born J, Aschoff J (1988) VEP, physiological and psychological circadian variations in humans. J Neurol 235(5):308–313PubMedCrossRef Stolz G, Aschoff JC, Born J, Aschoff J (1988) VEP, physiological and psychological circadian variations in humans. J Neurol 235(5):308–313PubMedCrossRef
18.
go back to reference York D, Pulliam MW, Rosenfeld JG, Watts C (1981) Relationship between visual evoked potentials and intracranial pressure. J Neurosurg 55:909–916PubMedCrossRef York D, Pulliam MW, Rosenfeld JG, Watts C (1981) Relationship between visual evoked potentials and intracranial pressure. J Neurosurg 55:909–916PubMedCrossRef
19.
go back to reference Wohns RN, Colpitts M, Colpitts Y, Clement T, Blackett WB (1987) Effect of high altitude on the visual evoked responses in humans on Mt. Everest Neurosurgery 21(3):352–356CrossRef Wohns RN, Colpitts M, Colpitts Y, Clement T, Blackett WB (1987) Effect of high altitude on the visual evoked responses in humans on Mt. Everest Neurosurgery 21(3):352–356CrossRef
20.
go back to reference York D, Legan M, Benner S, Watts C (1984) Further studies with a noninvasive method of intracranial pressure estimation. Neurosurgery 14(4):456–461PubMedCrossRef York D, Legan M, Benner S, Watts C (1984) Further studies with a noninvasive method of intracranial pressure estimation. Neurosurgery 14(4):456–461PubMedCrossRef
21.
go back to reference Young RS, Kimura E (2010) Statistical test of VEP waveform equality. Doc Ophthalmol 120(2):121–135PubMedCrossRef Young RS, Kimura E (2010) Statistical test of VEP waveform equality. Doc Ophthalmol 120(2):121–135PubMedCrossRef
22.
go back to reference Zhao YL, Zhou JY, Zhu GH (2005) Clinical experience with the noninvasive ICP monitoring system. Acta Neurochir (Wein) 95:351–355CrossRef Zhao YL, Zhou JY, Zhu GH (2005) Clinical experience with the noninvasive ICP monitoring system. Acta Neurochir (Wein) 95:351–355CrossRef
Metadata
Title
Flash visual evoked potentials are unreliable as markers of ICP due to high variability in normal subjects
Authors
Linnea Andersson
Johanna Sjölund
Josefin Nilsson
Publication date
01-01-2012
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2012
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-011-1152-9

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