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      <h1 class="highwire-cite-title" id="page-title">Optic Nerve Evaluation in Idiopathic Intracranial Hypertension</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. De Bernardo</span>, <span class="highwire-citation-author" data-delta="1">L. Vitiello</span> and <span class="highwire-citation-author" data-delta="2">N. Rosa</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E36; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6091 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-68501--61684097513" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. De Bernardo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Medicine, Surgery, and Dentistry
Scuola Medica Salernitana
University of Salerno
Salerno, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BDe%2BBernardo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=De%20Bernardo%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BDe%2BBernardo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4566-0064" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. De Bernardo</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">L. Vitiello </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Medicine, Surgery, and Dentistry
Scuola Medica Salernitana
University of Salerno
Salerno, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BVitiello%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vitiello%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BVitiello%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7867-3342" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Vitiello</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">N. Rosa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Medicine, Surgery, and Dentistry
Scuola Medica Salernitana
University of Salerno
Salerno, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BRosa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rosa%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BRosa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2366-6556" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Rosa</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with great interest the article by Golden et al <sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> concerning the use of MR imaging with contrast-enhanced 3D-FLAIR imaging in patients with idiopathic intracranial hypertension (IIH). We would like to congratulate the authors for their fascinating study but would like to make some comments on the methodology used to conduct the research.</p><p id="p-2">The authors used MR imaging in patients with IIH and control subjects to study the optic nerve and the optic nerve head and correlated their findings to the Frisén scale, an ophthalmologic scale for grading papilledema severity.</p><p id="p-3">We have some concerns about the method used because Hayreh,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> in 2016, showed that the appearance of the optic nerve head does not simultaneously correlate with the measurement of intracranial pressure (ICP). In fact, as the authors correctly stated in the discussion, the appearance of papilledema is related to the elevated ICP that expresses itself with axoplasmic stasis and ischemia, with subsequent neurotoxicity. Thus, in the case of IIH, the optic disc could still appear edematous when the ICP is normalized or, to the contrary, could even be normal in the early phase of ICP increase.</p><p id="p-4">Thus, recently, several articles have suggested using sonography to safely and noninvasively detect ICP and follow patients with high ICP, but unfortunately most of the authors used the B-scan technique, which, in our opinion, is not very reliable for this purpose.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup></p><p id="p-5">In our opinion, a standardized A-scan, first introduced by K.C.<sup><a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a></sup> Ossoinig in late 1970s is much more sensitive for this purpose because it can immediately detect the presence of high ICP or even differentiate papilledema from pseudopapilledema (eg, in case of optic nerve drusen).</p><p id="p-6">Furthermore, MR imaging is mandatory to exclude or determine the reason for the high ICP, but when a diagnosis of benign intracranial hypertension is entertained, we see no reason to use MR imaging to follow these patients when a cheaper and less invasive technique such as sonography can be used.</p><div class="section ref-list" id="ref-list-1"><h2 class="">REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-40.7.E36.1" data-doi="10.3174/ajnr.A5937"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Golden</span>  <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Krivochenitser</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mathews</span>  <span class="cit-name-given-names">N</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Contrast-enhanced 3D-FLAIR imaging of the optic nerve and optic nerve head: novel neuroimaging findings of idiopathic intracranial hypertension</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">40</span>:<span class="cit-fpage">334</span>–<span class="cit-lpage">39</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A5937</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>30679213</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0MC8yLzMzNCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci80MC83L0UzNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-40.7.E36.2" data-doi="10.1016/j.preteyeres.2015.10.001"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Hayreh</span>  <span class="cit-name-given-names">SS</span></span></li></ol><cite>. <span class="cit-article-title">Pathogenesis of optic disc edema in raised intracranial pressure</span>. <abbr class="cit-jnl-abbrev">Prog Retin Eye Res</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">50</span>:<span class="cit-fpage">108</span>–<span class="cit-lpage">44</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1016/j.preteyeres.2015.10.001</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26453995</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.preteyeres.2015.10.001&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=26453995&amp;link_type=MED&amp;atom=%2Fajnr%2F40%2F7%2FE36.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-40.7.E36.3" data-doi="10.1002/jum.14198"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Iaconetta</span>  <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">De Bernardo</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rosa</span>  <span class="cit-name-given-names">N</span></span></li></ol><cite>. <span class="cit-article-title">Coronal axis measurement of the optic nerve sheath diameter</span>. <abbr class="cit-jnl-abbrev">J Ultrasound Med</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">1073</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1002/jum.14198</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28390163</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1002/jum.14198&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=28390163&amp;link_type=MED&amp;atom=%2Fajnr%2F40%2F7%2FE36.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-40.7.E36.4" data-doi="10.1001/jamaophthalmol.2017.2597"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">De Bernardo</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rosa</span>  <span class="cit-name-given-names">N</span></span></li></ol><cite>. <span class="cit-article-title">Clarification on using ultrasonography to detect intracranial pressure</span>. <abbr class="cit-jnl-abbrev">JAMA Ophthalmol</abbr> <span class="cit-pub-date">2017</span>;<span class="cit-vol">135</span>:<span class="cit-fpage">1004</span>–<span class="cit-lpage">05</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1001/jamaophthalmol.2017.2597</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>28772288</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1001/jamaophthalmol.2017.2597&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=28772288&amp;link_type=MED&amp;atom=%2Fajnr%2F40%2F7%2FE36.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-book" id="cit-40.7.E36.5"><div class="cit-metadata"><ol class="duplicate"><li><span class="cit-ed"><span class="cit-name-surname">Till</span>  <span class="cit-name-given-names">P</span></span></li></ol><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Ossoinig</span>  <span class="cit-name-given-names">KC</span></span></li></ol><cite>. <span class="cit-article-title">Standardized echography of the optic nerve</span>. In: <span class="cit-ed"><span class="cit-name-surname">Till</span>  <span class="cit-name-given-names">P</span></span>, ed. <span class="cit-source">Documenta Ophthalmologica Proceedings Series vol 55, Ophthalmic echography 13</span>. <span class="cit-publ-loc">Dordrecht</span>: <span class="cit-publ-name">Springer Netherlands</span>; <span class="cit-pub-date">1990</span>, <span class="cit-fpage">3</span>–<span class="cit-lpage">99</span></cite></div><div class="cit-extra"></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2019 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 40</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jul 2019 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.</span> <span class="nlm-surname">De Bernardo</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Vitiello</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Rosa</span></span></span></div>
  
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