1
|
Hauser RA, Matias D, Rawlings B. The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: emphasis on obstruction of fluid flow into and out of the brain. Front Neurol 2024; 15:1430390. [PMID: 39677863 PMCID: PMC11638589 DOI: 10.3389/fneur.2024.1430390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/07/2024] [Indexed: 12/17/2024] Open
Abstract
Ligamentous cervical instability, especially ligamentous upper cervical instability, can be the missing structural cause and/or co-morbidity for many chronic disabling brain and systemic body symptoms and diagnoses. Due to the forward head-facedown lifestyle from excessive computer and cell phone usage, the posterior ligament complex of the cervical spine undergoes a slow stretch termed "creep" which can, over time, lead to cervical instability and a breakdown of the cervical curve. As this degenerative process continues, the cervical curve straightens and ultimately becomes kyphotic, a process called cervical dysstructure; simultaneously, the atlas (C1) moves forward, both of which can lead to encroachment of the structures in the carotid sheath, especially the internal jugular veins and vagus nerves. This obstruction of fluid flow can account for many brain diseases, and compression and stretch of the vagus nerve for body diseases, including dysautonomia. This article describes the consequences of impaired fluid flow into and out of the brain, especially venous flow through the internal jugular veins, leading to intracranial hypertension (formerly called pseudotumor cerebri). Cervical structural, internal jugular vein, and optic nerve sheath measurements are presented from a retrospective chart review of 227 consecutive patients with no obvious cause for 1 of 8 specific brain or mental health symptoms-anxiety, brain fog, concentration difficulty, depression/hopelessness, headaches, obsessive thoughts, panic attacks, and rumination on traumatic events. A case example is given to demonstrate how cervical structural treatments can open up internal jugular veins and improve a patient's chronic symptoms.
Collapse
Affiliation(s)
| | | | - B. Rawlings
- Caring Medical Florida, Fort Myers, FL, United States
| |
Collapse
|
2
|
Lee YO, Kim H, Chung YW, Cho WK, Park J, Paik JS. Segmentation-Based Measurement of Orbital Structures: Achievements in Eyeball Volume Estimation and Barriers in Optic Nerve Analysis. Diagnostics (Basel) 2024; 14:2643. [PMID: 39682551 DOI: 10.3390/diagnostics14232643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/16/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVE Orbital diseases often require precise measurements of eyeball volume, optic nerve sheath diameter (ONSD), and apex-to-eyeball distance (AED) for accurate diagnosis and treatment planning. This study aims to automate and optimize these measurements using advanced deep learning segmentation techniques on orbital Computed Tomography (CT) scans. METHODS Orbital CT datasets from individuals of various age groups and genders were used, with annotated masks for the eyeball and optic nerve. A 2D attention U-Net architecture was employed for segmentation, enhanced with slice-level information embeddings to improve contextual understanding. After segmentation, the relevant metrics were calculated from the segmented structures and evaluated for clinical applicability. RESULTS The segmentation model demonstrated varying performance across orbital structures, achieving a Dice score of 0.8466 for the eyeball and 0.6387 for the optic nerve. Consequently, eyeball-related metrics, such as eyeball volume, exhibited high accuracy, with a root mean square error (RMSE) of 1.28-1.90 cm3 and a mean absolute percentage error (MAPE) of 12-21% across different genders and age groups. In contrast, the lower accuracy of optic nerve segmentation led to less reliable measurements of optic nerve sheath diameter (ONSD) and apex-to-eyeball distance (AED). Additionally, the study analyzed the automatically calculated measurements from various perspectives, revealing key insights and areas for improvement. CONCLUSIONS Despite these challenges, the study highlights the potential of deep learning-based segmentation to automate the assessment of ocular structures, particularly in measuring eyeball volume, while leaving room for further improvement in optic nerve analysis.
Collapse
Affiliation(s)
- Yong Oh Lee
- Department of Industrial and Data Engineering, Hongik University, Seoul 04066, Republic of Korea
| | - Hana Kim
- Department of Computer Engineering, Hongik University, Seoul 04066, Republic of Korea
| | - Yeong Woong Chung
- Department of Ophthalmology and Visual Science, The Catholic University of Korea, St. Vincent's Hospital, Suwon 16247, Republic of Korea
| | - Won-Kyung Cho
- Department of Ophthalmology and Visual Science, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu 11765, Republic of Korea
| | - Jungyul Park
- Department of Ophthalmology and Visual Science, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 06591, Republic of Korea
| | - Ji-Sun Paik
- Department of Ophthalmology and Visual Science, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul 07345, Republic of Korea
| |
Collapse
|
3
|
Jiang H, Xie Z, Yang L, Wang H. Pcv-aCO 2/Ca-cvO 2 Combined with Optic Nerve Sheath Diameter in Predicting Elevated Intracranial Pressure of Patients with Traumatic Brain Injury in Prehospital Setting. Int J Gen Med 2024; 17:4519-4528. [PMID: 39398485 PMCID: PMC11468361 DOI: 10.2147/ijgm.s475225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024] Open
Abstract
Purpose To investigate a correlation between the central venous minus arterial CO2 pressure to arterial minus central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) combined with optic nerve sheath diameter (ONSD) in predicting prehospital elevated intracranial pressure (ICP) in traumatic brain injury (TBI) patients. Patients and Methods This was a prospective observational study of all adult TBI patients from the surgical intensive care unit who underwent invasive ICP monitoring between January 2023 and December 2023. Using a Delica MVU-6300 machine with 14-5 MHz linear probe to measure ONSD. We drew blood samples for arterial and central venous blood gases to measure and calculate the following indicators such as Pcv-aCO2, Ca-cvO2, and Pcv-aCO2/Ca-cvO2 ratio. ONSD and Pcv-aCO2/Ca-cvO2 were recorded during the first 3 days after admission. Simultaneous ICP values were gained from the invasive monitoring. Associations between ONSD, Pcv-aCO2/Ca-cvO2 and simultaneous ICP were explored by Spearman correlation analysis. We constructed an ROC curve to identify the ONSD and Pcv-aCO2/Ca-cvO2 cutoff for the evaluation of elevated ICP. Results We included 54 patients aged mean 57.13 (standard deviation 4.02) years and 24 (44%) were male. A significant correlation was observed between ONSD and ICP (r = 0.74, P < 0.01). The AUC was 0.861 (95% CI: 0.727-0.951), with a best cutoff value of 5.62 mm. Using a cutoff of 5.62mm, ONSD had a sensitivity of 92.8%, specificity of 80.4%. The Pcv-aCO2/Ca-cvO2 ratio also significantly correlated with ICP (r = 0.70, P < 0.01). The AUC was 0.791 (95% CI: 0.673-0.889). The optimal Pcv-aCO2/Ca-cvO2 value for predicting elevated ICP was 1.98 mmHg/mL. Using a cutoff of 1.98 mmHg/mL, Pcv-aCO2/Ca-cvO2 had a sensitivity of 87.3%, specificity of 77.2%. The AUC for ONSD combined with Pcv-aCO2/Ca-cvO2 was 0.952 (95% CI: 0.869-0.971), which had a sensitivity of 95.1%, specificity of 93.9%. Conclusion Pcv-aCO2/Ca-cvO2 combined with ONSD performed best in predicting elevated intracranial pressure of patients with TBI in a prehospital setting. Our findings provide a crucial tool to improve earlier management of these patients in prehospital care, where the availability and utilization of invasive monitoring is limited. It could lead to significant changes in how TBI patients are monitored and treated before reaching a hospital.
Collapse
Affiliation(s)
- Hui Jiang
- Department of Emergency Medical Service, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Zhihui Xie
- Department of Emergency Medical Service, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Liu Yang
- Department of Emergency Medical Service, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| | - Huiting Wang
- Department of Emergency, The First People’s Hospital of Changde City, Changde, Hunan Province, People’s Republic of China
| |
Collapse
|
4
|
Zhang D, Sheng Y, Wang C, Chen W, Shi X. Global traumatic brain injury intracranial pressure: from monitoring to surgical decision. Front Neurol 2024; 15:1423329. [PMID: 39355091 PMCID: PMC11442239 DOI: 10.3389/fneur.2024.1423329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 09/02/2024] [Indexed: 10/03/2024] Open
Abstract
Traumatic brain injury (TBI) is a significant global public health issue, heavily impacting human health, especially in low-and middle-income areas. Despite numerous guidelines and consensus statements, TBI fatality rates remain high. The pathogenesis of severe TBI is closely linked to rising intracranial pressure (ICP). Elevated intracranial pressure can lead to cerebral herniation, resulting in respiratory and circulatory collapse, and ultimately, death. Managing intracranial pressure (ICP) is crucial in neuro-intensive care. Timely diagnosis and precise treatment of elevated ICP are essential. ICP monitoring provides real-time insights into a patient's condition, offering invaluable guidance for comprehensive management. ICP monitoring and standardization can effectively reduce secondary nerve damage, lowering morbidity and mortality rates. Accurately assessing and using true ICP values to manage TBI patients still depends on doctors' clinical experience. This review discusses: (a) Epidemiological disparities of traumatic brain injuries across countries with different income levels worldwide; (b) The significance and function of ICP monitoring; (c) Current status and challenges of ICP monitoring; (d) The impact of decompressive craniectomy on reducing intracranial pressure; and (e) Management of TBI in diverse income countries. We suggest a thorough evaluation of ICP monitoring, head CT findings, and GCS scores before deciding on decompressive craniectomy. Personalized treatment should be emphasized to assess the need for surgical decompression in TBI patients, offering crucial insights for clinical decision-making.
Collapse
Affiliation(s)
- Dan Zhang
- Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Yanzhi Sheng
- Shenzhen College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Chengbin Wang
- Shenzhen College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Wei Chen
- Longgang Central Hospital of Shenzhen, Guangdong, China
| | - Xiaofeng Shi
- Longgang Central Hospital of Shenzhen, Guangdong, China
| |
Collapse
|
5
|
Brawanski K, Petr O, Hernandez CP, Kögl N, Thomé C, Gizewski ER, Gruber H, Verius M, Gruber L, Putzer D. Superb microvascular ultrasound is a promising non-invasive diagnostic tool to assess a ventriculoperitoneal shunt system function: a feasibility study. Neurosurg Rev 2024; 47:521. [PMID: 39222164 PMCID: PMC11369043 DOI: 10.1007/s10143-024-02665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
The objective of this pilot study was to assess the reliability of superb microvascular ultrasound (SMI) for the measurement of the cerebrospinal fluid (CSF) flow within VPS systems as an indirect sign for shunt dysfunction. Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (N = 19) patients in the proximal and in 89.5% (N = 17) in the distal catheter. The distal catheter tip was detectable in 27.7% (N = 5) patients. Free intraabdominal fluid was initially detected in 21.4% (N = 4) patients and in 57.9% (N = 11) at the end of the examination (P = 0.049). ONSD was significantly lower after pump activation (4.4 ± 0.9 mm versus 4.1 ± 0.8 mm, P = 0.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2 ± 45.2 versus 5.6 ± 3.7 cm/sec, P = 0.015; 16.6 ± 9.5 ml/sec versus 5.1 ± 4.0 ml/sec, P = 0.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (P = 0.975) or PD (P = 0.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system.
Collapse
Affiliation(s)
- Konstantin Brawanski
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria.
| | | | - Nikolaus Kögl
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Elke R Gizewski
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Michael Verius
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Daniel Putzer
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| |
Collapse
|
6
|
Rehab OM, Elsharkawy MS, Bakr DM, Hassan AA. Effect of systemic lidocaine infusion on optic nerve sheath diameter during laparoscopic hysterectomy: a randomized controlled study. Minerva Anestesiol 2024; 90:727-738. [PMID: 39279479 DOI: 10.23736/s0375-9393.24.18204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
BACKGROUND During laparoscopic hysterectomy (LH), the elevation of intra-abdominal and intra-thoracic pressures due to pneumoperitoneum (PP) results in an increase in intracranial pressure (ICP). The Trendelenburg position (TP) is an accentuating factor. This trial aimed to assess the effect of intravenous (IV) lidocaine infusion on optic nerve sheath diameter (ONSD), a widely accepted surrogate measure for ICP, during PP and TP. METHODS A randomized, placebo-controlled study was conducted on 66 patients scheduled for LH, equally divided into a lidocaine group and a saline group. ONSD, the primary outcome, was recorded before induction (T1), before PP initiation in the supine position (T2), five minutes (T3), 30 minutes (T4), and 60 minutes (T5) after PP and TP, and five minutes after termination of PP in the supine position (T6). Secondary outcomes included numerical rating scale (NRS) scores at arrival to the post-anesthesia care unit (PACU), 6, 12, and 24 hours after surgery, and postoperative adverse effects. RESULTS ONSD at T4 and T5 was significantly lower in the lidocaine group than in the saline group (T4: 4.94±0.43 mm vs. 5.27±0.37 mm; P =0.003, T5: 5.08±0.46 vs. 5.41±0.38 mm; P =0.004). The lidocaine group had significantly lower NRS values than the saline group only at PACU arrival (median [Q1-Q3]: 5 [4-6] vs. 6 [5-6.25]; P =0.016). Fewer patients in the lidocaine group experienced postoperative headache (P =0.029). CONCLUSIONS IV lidocaine during LH can attenuate the ONSD distension, decrease pain scores at PACU arrival, and reduce the incidence of postoperative headache.
Collapse
Affiliation(s)
- Osama M Rehab
- Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Mohammed S Elsharkawy
- Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doha M Bakr
- Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Adel A Hassan
- Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| |
Collapse
|
7
|
Hezenci Y, Bulut M, Demirel O. Effect of rapid maxillary expansion on intracranial pressure. Heliyon 2024; 10:e36409. [PMID: 39253265 PMCID: PMC11382073 DOI: 10.1016/j.heliyon.2024.e36409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
Objective The aim of this study was to evaluate the effects of rapid maxillary expansion on the optic nerve sheath diameter and to examine its possible effects on intracranial pressure. Design 20 patients with bilateral crossbite were selected. Hyrax Expander was applied and activated twice daily until the overcorrection was achieved. The optic nerve sheath diameter (ONSD) was measured via ultrasonography before the first activation (T0), then repeated after 1 (T1) and 10 min (T2). At the end of the expansion, ONSD was measured (T3) again, then the screw was activated for the last time, and measurements were repeated after 1 (T4) and 10 min (T5). The Friedman test was performed to compare the changes, and The Wilcoxon Signed-Rank test was done to determine the significant intergroup changes (p < 0.05). Results The ONSD increased significantly 1 min after the activations (T0-T1 and T3-T4) (P < 0.05). The ONSD values measured 10 min after the activations also increased significantly compared to the baseline values (T0-T2 and T3-T5) (P < 0.05). Conclusion The activation of maxillary expansion appliances increased the optic nerve sheath diameter in adolescents. Therefore, orthodontists should be careful with patients at risk of intracranial hypertension.
Collapse
Affiliation(s)
- Yasin Hezenci
- Department of Orthodontics, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Musa Bulut
- Department of Orthodontics, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Oğuzhan Demirel
- Department of Dentomaxillofacial Radiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| |
Collapse
|
8
|
Berhanu D, Carneiro I, Antunes AP, Abegão Pinto L, Fragata I, Tavares Ferreira J, Lucas Neto L. Dimensions of Arachnoid Bulk Ratio: A Superior Optic Nerve Sheath Index for Intracranial Pressure. Radiology 2024; 312:e240114. [PMID: 38980182 DOI: 10.1148/radiol.240114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background Discrepancies in the literature regarding optimal optic nerve sheath diameter (ONSD) cutoffs for intracranial pressure (ICP) necessitate alternative neuroimaging parameters to improve clinical management. Purpose To evaluate the diagnostic accuracy of the dimensions of the perineural subarachnoid space to the optic nerve sheath ratio, measured using US, in predicting increased ICP. Materials and Methods In a prospective cohort study from April 2022 to December 2023, patients with suspected increased ICP underwent optic nerve US to determine the dimensions of arachnoid bulk (DAB) ratio and ONSD before invasive ICP measurement. Correlation between the parameters and ICP, as well as diagnostic accuracy, was assessed using area under the receiver operating characteristic curve (AUC) analysis. Results A total of 30 participants were included (mean age, 39 years ± 14 [SD]; 24 female). The DAB ratio and ONSD were significantly larger in participants with increased ICP (38% [0.16 of 0.42] and 14% [0.82 of 6.04 mm], respectively; P < .001). The DAB ratio showed a stronger correlation with ICP than ONSD (rs = 0.87 [P < .001] vs rs = 0.61 [P < .001]). The DAB ratio and ONSD optimal cutoffs for increased ICP were 0.5 and 6.5 mm, respectively, and the ratio had higher sensitivity (100% vs 92%) and specificity (94% vs 83%) compared with ONSD. Moreover, the DAB ratio better predicted increased ICP than ONSD, with a higher AUC (0.98 [95% CI: 0.95, 1.00] vs 0.86 [95% CI: 0.71, 0.95], P = .047). Conclusion An imaging ratio was proposed to predict ICP based on the relative anatomy of the cerebrospinal fluid space, demonstrating more accurate diagnosis of increased ICP and a strong correlation with ICP values, suggesting its potential utility as a neuroimaging marker in clinical settings. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Shepherd in this issue.
Collapse
Affiliation(s)
- David Berhanu
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Inês Carneiro
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Ana Patrícia Antunes
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Luís Abegão Pinto
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Isabel Fragata
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Joana Tavares Ferreira
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| | - Lia Lucas Neto
- From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.)
| |
Collapse
|
9
|
Heredia-Orbegoso O, Vences MA, Failoc-Rojas VE, Fernández-Merjildo D, Lainez-Chacon RH, Villamonte R. Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru. Front Neurol 2024; 15:1340749. [PMID: 38765265 PMCID: PMC11099257 DOI: 10.3389/fneur.2024.1340749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Aim We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
Collapse
Affiliation(s)
- Omar Heredia-Orbegoso
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | | | | | | | - Richard H. Lainez-Chacon
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | - Renán Villamonte
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| |
Collapse
|
10
|
Hohmann C, Doulis AE, Gietzen CH, Adler C, Wienemann H, von Stein P, Hoerster R, Koch KR, Michels G. Optic Nerve Sheath Diameter for Assessing Prognosis after Out-of-Hospital Cardiac Arrest. J Crit Care 2024; 79:154464. [PMID: 37948943 DOI: 10.1016/j.jcrc.2023.154464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Evaluate optic nerve sheath and pial diameters (ONSD, ONPD) via sonography and computed tomography (CT) after out-of-hospital cardiac arrest (CA) and to compare their prognostic significance with other imaging and laboratory biomarkers. MATERIALS AND METHODS A prospective observational study enrolling patients after successful resuscitation between December 2017 and August 2021. ONSD and ONPD were measured with sonography. Additionally, ONSD, and also grey-to-white ratio at basal ganglia (GWRBG) and cerebrum (GWRCBR), were assessed using CT. Lactate and neuron specific enolase (NSE) blood levels were measured. RESULTS Sonographically measured ONSD and ONPD yielded no significant difference between survival and non-survival (p values ≥0.4). Meanwhile, CT assessed ONSD, GWRBG, GWRCBR, and NSE levels significantly differed regarding both, survival (p values ≤0.005) and neurological outcome groups (p values ≤0.04). For survival prognosis, GWRBG, GWRCBR, and NSE levels appeared as excellent predictors; in predicting a good neurological outcome, NSE had the highest accuracy. CONCLUSIONS CT diagnostics, in particular GWRBG and GWRCBR, as well as NSE as laboratory biomarker, appear as excellent outcome predictors. Meanwhile, our data lead us to recommend caution in utilizing sonography assessed ONSD and ONPD for prognostic decision-making post-CA.
Collapse
Affiliation(s)
- Christopher Hohmann
- Department III of Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Alexandros E Doulis
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carsten H Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christoph Adler
- Department III of Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Hendrik Wienemann
- Department III of Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Philipp von Stein
- Department III of Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Robert Hoerster
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; MVZ ADTC Moenchengladbach-Erkelenz, Erkelenz, Germany.
| | - Konrad R Koch
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; MVZ ADTC Moenchengladbach-Erkelenz, Erkelenz, Germany.
| | - Guido Michels
- Department of Emergency Medicine, Hospital of the Barmherzige Brüder Trier, Germany.
| |
Collapse
|
11
|
Xie Y, Fu Y, Shao Y, Qu L, Yang J, Yang C, Zhou K, Li K, Xu Z, Xu D, Cao K, Tian N, Lv K, Wang L, Wang Y, Wang N, Li Y. Quantitative ultrasound image assessment of the optic nerve subarachnoid space during 90-day head-down tilt bed rest. NPJ Microgravity 2024; 10:9. [PMID: 38233425 PMCID: PMC10794463 DOI: 10.1038/s41526-024-00347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
The elevation in the optic nerve sheath (ONS) pressure (ONSP) due to microgravity-induced headward fluid shift is the primary hypothesized contributor to SANS. This longitudinal study aims to quantify the axial plane of the optic nerve subarachnoid space area (ONSSA), which is filled with cerebrospinal fluid (CSF) and expands with elevated ONSP during and after head-down tilt (HDT) bed rest (BR). 36 healthy male volunteers (72 eyes) underwent a 90-day strict 6° HDT BR. Without obtaining the pre-HDT data, measurements were performed on days 30, 60, and 90 during HDT and at 6 recovery time points extended to 180-days (R + 180) in a supine position. Portable B-scan ultrasound was performed using the 12 MHz linear array probe binocularly. The measurements of the ONS and the calculation of the ONSSA were performed with ImageJ 1.51 analysis software by two experienced observers in a masked manner. Compared to R + 180, the ONSSA on HDT30, HDT60, and HDT90 exhibited a consistently significant distention of 0.44 mm2 (95% CI: 0.13 to 0.76 mm2, P = 0.001), 0.45 mm2 (95% CI: 0.15 to 0.75 mm2, P = 0.001), and 0.46 mm2 (95% CI: 0.15 to 0.76 mm2, P < 0.001), respectively, and recovered immediately after HDT on R + 2. Such small changes in the ONSSA were below the lateral resolution limit of ultrasound (0.4 mm) and may not be clinically relevant, possibly due to ONS hysteresis causing persistent ONS distension. Future research can explore advanced quantitative portable ultrasound-based techniques and establish comparisons containing the pre-HDT measurements to deepen our understanding of SANS.
Collapse
Affiliation(s)
- Yuan Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Yingdi Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, 100730, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Yaqi Shao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, 100730, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Lina Qu
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Jiangang Yang
- Xi'an No.1 Hospital; Shanxi Institute of Ophthalmology; Shanxi Key Laboratory of Ophthalmology; Clinical Research Center for Ophthalmology Diseases of Shanxi Province; the First Affiliated Hospital of Northwestern University, Xi'an, 710002, Shanxi Province, China
| | - Chengjia Yang
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Kun Zhou
- Xi'an No.1 Hospital; Shanxi Institute of Ophthalmology; Shanxi Key Laboratory of Ophthalmology; Clinical Research Center for Ophthalmology Diseases of Shanxi Province; the First Affiliated Hospital of Northwestern University, Xi'an, 710002, Shanxi Province, China
| | - Kai Li
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Zi Xu
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Dong Xu
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Ning Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Ke Lv
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Linjie Wang
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Yaping Wang
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, 100730, China.
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China.
| | - Yinghui Li
- China Astronaut Research and Training Center, State Key Lab of Space Medicine Fundamentals and Application, No. 26 Beiqing Road, Haidian District, Beijing, 100094, China.
| |
Collapse
|
12
|
Demir M, Balkiz Soyal Ö, Aytaç BG. Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Prospective, Randomized, Controlled Double-Blinded Comparison of Propofol and Ketofol Anesthesia. Niger J Clin Pract 2024; 27:22-28. [PMID: 38317031 DOI: 10.4103/njcp.njcp_876_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia. MATERIAL/METHODS One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4). RESULTS Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000). CONCLUSIONS ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.
Collapse
Affiliation(s)
- M Demir
- Anesthesiology Department, Kars Kağızman State Hospital, Kars, Turkey
| | - Ö Balkiz Soyal
- Anesthesiology Department, Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - B G Aytaç
- Anesthesiology Department, Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| |
Collapse
|
13
|
Janitschke D, Stögbauer J, Lattanzi S, Brigo F, Lochner P. B-mode transorbital ultrasonography for the diagnosis of idiopathic intracranial hypertension: an updated systematic review and meta-analysis. Neurol Sci 2023; 44:4313-4322. [PMID: 37599314 DOI: 10.1007/s10072-023-07016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the role of B-mode transorbital ultrasonography (TOS) for the diagnosis of idiopathic intracranial hypertension (IIH) in adults. METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) (1966-May 2022) were searched to identify studies reporting ultrasonographic data about the optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) in adults with IIH compared to subjects without IIH. The quality of the included studies was evaluated by the Newcastle-Ottawa Quality. RESULTS Fifteen studies were included (total of 439 patients). The values of ODE ranged from 0.6 to 1.3 mm in patients with IIH. The values of ONSD ranged from 4.7 to 6.8 mm in IIH patients and from 3.9 to 5.7 mm in controls. In IIH patients, the ONSD was significantly higher compared to controls (standardized mean difference: 2.5 mm, 95% confidence interval (CI): 1.6-3.4 mm). Nine studies provided data about the presence of papilledema and the pooled prevalence was 95% (95% CI, 92-97%). CONCLUSIONS In adults, the thickness of ONSD and the entity of ODE were significantly associated with IIH. B-mode TOS enables to noninvasively detect increased ICP and should be performed, potentially routinely, in any patient with suspected IIH.
Collapse
Affiliation(s)
- Daniel Janitschke
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany
| | - Jakob Stögbauer
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany.
| |
Collapse
|
14
|
Zhang Y, Cao K, Pang R, Wang N, Qu X, Kang J, Wang N, Liu H. Non-invasive intracranial pressure estimation using ultrasonographic measurement of area of optic nerve subarachnoid space. Br J Ophthalmol 2023; 107:1716-1721. [PMID: 36002239 DOI: 10.1136/bjo-2022-321065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To verify whether the area of the ONSAS (ONSASA) obtained by transorbital ultrasonography can be used to accurately evaluate the intracranial pressure (ICP). METHODS The recorded indexes included the optic nerve diameter, the optic nerve sheath diameter (ONSD), the width of both sides of the ONSAS (ONSASW) at 3 mm from the optic nerve head and the entire ONSASA outlined between 3 and 7 mm. After exploring and comparing five models to describe the relationship between body mass index (BMI), mean arterial blood pressure (MABP), ONSASA and ICP, the best model was determined. RESULTS In all, 90 patients with neurological diseases undergoing continuous invasive ICP monitoring were included in the study. In the training group, the correlation coefficient for the association between the ICP and ONSASA (Pearson's correlation r=0.953) was higher than that for the association of the ICP with the ONSD (r=0.672; p<0.0001) and ONSASW at 3 mm behind the globe (r=0.691; p<0.0001). In the training group, the weighting function for prediction of the ICP was as follows: non-invasive ICP=2.050×ONSASA-0.051×BMI +0.036*MABP-5.837. With 20 mm Hg as the cut-off point for a high or low ICP, the sensitivity and specificity of ONSASA predicting ICP was 1.00 and 0.92. Receiver operator curve analysis revealed that the calculated cut-off value for predicting elevated ICP was 19.96 (area under curve= 0.960, 95% CI 0.865 to 1.00). CONCLUSION Measurement of the ONSASA using ultrasonography can serve as a practical method for rapid and non-invasive quantification for evaluating ICP through an accurate mathematical formula with the BMI and MABP considered as contributing parameters. TRIAL REGISTRATION NUMBER The study was registered in the Chinese Clinical Trial Registry (Study no ChiCTR2100045274).
Collapse
Affiliation(s)
- Yue Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Pang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ning Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xin Qu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| |
Collapse
|
15
|
Ustick JJ, Pardon LP, Chettry P, Patel NB, Cheng H. Effects of head-down tilt on optic nerve sheath diameter in healthy subjects. Ophthalmic Physiol Opt 2023; 43:1531-1539. [PMID: 37401194 PMCID: PMC10592427 DOI: 10.1111/opo.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Intracranial pressure increases in head-down tilt (HDT) body posture. This study evaluated the effect of HDT on the optic nerve sheath diameter (ONSD) in normal subjects. METHODS Twenty six healthy adults (age 28 [4.7] years) participated in seated and 6° HDT visits. For each visit, subjects presented at 11:00 h for baseline seated scans and then maintained a seated or 6° HDT posture from 12:00 to 15:00 h. Three horizontal axial and three vertical axial scans were obtained at 11:00, 12:00 and 15:00 h with a 10 MHz ultrasonography probe on the same eye, randomly chosen per subject. At each time point, horizontal and vertical ONSD (mm) were quantified by averaging three measures taken 3 mm behind the globe. RESULTS In the seated visit, ONSDs were similar across time (p > 0.05), with an overall mean (standard deviation) of 4.71 (0.48) horizontally and 5.08 (0.44) vertically. ONSD was larger vertically than horizontally at each time point (p < 0.001). In the HDT visit, ONSD was significantly enlarged from baseline at 12:00 and 15:00 h (p < 0.001 horizontal and p < 0.05 vertical). Mean (standard error) horizontal ONSD change from baseline was 0.37 (0.07) HDT versus 0.10 (0.05) seated at 12:00 h (p = 0.002) and 0.41 (0.09) HDT versus 0.12 (0.06) seated at 15:00 h (p = 0.002); mean vertical ONSD change was 0.14 (0.07) HDT versus -0.07 (0.04) seated at 12:00 h (p = 0.02) and 0.19 (0.06) HDT versus -0.03 (0.04) seated at 15:00 h (p = 0.01). ONSD change in HDT was similar between 12:00 and 15:00 h (p ≥ 0.30). Changes at 12:00 h correlated with those at 15:00 h for horizontal (r = 0.78, p < 0.001) and vertical ONSD (r = 0.73, p < 0.001). CONCLUSION The ONSD increased when body posture transitioned from seated to HDT position without any further change at the end of the 3 h in HDT.
Collapse
Affiliation(s)
| | - Laura P. Pardon
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Pratik Chettry
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Nimesh B. Patel
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Han Cheng
- University of Houston, College of Optometry, Houston, Texas, USA
| |
Collapse
|
16
|
Xu X, Lu Y, Liu J, Xu R, Zhao K, Tao A. Diagnostic Value of the Combination of Ultrasonographic Optic Nerve Sheath Diameter and Width of Crural Cistern with Respect to the Intracranial Pressure in Patients Treated with Decompressive Craniotomy. Neurocrit Care 2023; 39:436-444. [PMID: 37037992 DOI: 10.1007/s12028-023-01711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The monitoring of intracranial pressure (ICP) and detection of increased ICP are crucial because such increases may cause secondary brain injury and a poor prognosis. Although numerous ultrasound parameters, including optic nerve sheath diameter (ONSD), width of the crural cistern (WCC), and the flow velocities of the central retinal artery and middle cerebral artery, can be measured in patients after hemicraniectomy, researchers have yet to determine which of these is better for evaluating ICP. This study aimed to analyze the correlation between ICP and ultrasound parameters and investigate the best noninvasive estimator of ICP. METHODS This observational study enrolled 50 patients with brain injury after hemicraniectomy from January 2021 to December 2021. All patients underwent invasive ICP monitoring with microsensor, transcranial, and ocular ultrasound postoperatively. We measured the ONSD including the dura mater (ONSDI), the ONSD excluding the dura mater, the optic nerve diameter (OND), the eyeball transverse diameter (ETD), the WCC, and the flow velocities in the central retinal artery and middle cerebral artery. Then, we calculated the ONSDI-OND (the difference between ONSDI and OND) and ONSDI/ETD (the ratio of ONSDI to ETD). Patients were divided into a normal ICP group (n = 35) and an increased ICP group (≥ 20 mm Hg, n = 15) according to the ICP measurements. Correlations were then assessed between the values of the ultrasound parameters and ICP. RESULTS The ONSDI, ONSDI-OND, and ONSDI/ETD were positively associated with ICP (r = 0.455, 0.482, 0.423 and p = 0.001, < 0.001, 0.002, respectively), whereas the WCC was negatively associated with ICP (r = - 0.586, p < 0.001). The WCC showed the highest predictive power for increased ICP (area under the receiver operating characteristic curve [AUC] = 0.904), whereas the ONSDI-OND and ONSDI also presented with acceptable predictive power among the ONSD-related parameters (AUC = 0.831, 0.803, respectively). The cutoff values for increased ICP prediction for ONSDI, ONSDI-OND, and WCC were 6.29, 3.03, and 3.68 mm, respectively. The AUC of the combination of ONSDI-OND and WCC was 0.952 (95% confidence interval 0.896-1.0, p < 0.001). CONCLUSIONS The ONSDI, ONSDI-OND, and WCC were correlated with ICP and had acceptable accuracy levels in estimating ICP in patients after hemicraniectomy. Furthermore, WCC showed a higher diagnostic value than ONSD-related parameters, and the combination of ONSDI-OND and WCC was a satisfactory predictor of increased ICP.
Collapse
Affiliation(s)
- Xiaolan Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yajing Lu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jiqiao Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Renfan Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anyu Tao
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| |
Collapse
|
17
|
Trollip L, Alberto K, Makgotloe A. Optic Nerve Sheath Diameter: A Cross-Sectional Study of Ultrasonographic Measurement in Healthy Black South African Adults. Life (Basel) 2023; 13:1979. [PMID: 37895361 PMCID: PMC10608246 DOI: 10.3390/life13101979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
Ultrasonographic optic nerve sheath diameter (ONSD) measurement is an accurate, portable, and non-invasive method of detecting raised intracranial pressure that can also reflect dynamic, real-time changes in intracranial pressure fluctuations. Various studies have shown the mean range of ONSD to vary greatly across different population groups. This study aimed to determine the mean ONSD in healthy Black South African adults. In this cross-sectional study, healthy black South African adult participants underwent optic nerve sheath ultrasound of the right eye, with the diameter being measured at 3 mm behind the retina in two different planes. The average of the two measurements was used to find the mean optic nerve sheath diameter. This measurement was compared to that found in a Canadian adult population, and the effect of age, gender, and co-morbidities on ONSD was assessed. A total of 99 participants were included in this study, of which 39 were male and 60 were female. The mean ONSD was found to be 5.1 mm (SD ± 0.33). This value was significantly higher than the mean ONSD observed in the Canadian population (p < 0.001). There was no significant difference found between the mean ONSD in males and females (p = 0.652), and both age and presence of co-morbidities were not found to significantly correlate with ONSD. (p = 0.693 and p = 0.974, respectively).
Collapse
Affiliation(s)
- Lindy Trollip
- Department of Ophthalmology, University of Witwatersrand, Johannesburg 2193, South Africa; (K.A.); (A.M.)
| | | | | |
Collapse
|
18
|
Moore BT, Osika T, Satterly S, Shah S, Thirion T, Hampton S, Aylward S, Montgomery S. Evaluation of commercially available point-of-care ultrasound for automated optic nerve sheath measurement. Ultrasound J 2023; 15:33. [PMID: 37530991 PMCID: PMC10397168 DOI: 10.1186/s13089-023-00331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Measurement of the optic nerve sheath diameter (ONSD) via ultrasonography has been proposed as a non-invasive metric of intracranial pressure that may be employed during in-field patient triage. However, first responders are not typically trained to conduct sonographic exams and/or do not have access to an expensive ultrasound device. Therefore, for successful deployment of ONSD measurement in-field, we believe that first responders must have access to low-cost, portable ultrasound and be assisted by artificial intelligence (AI) systems that can automatically interpret the optic nerve sheath ultrasound scan. We examine the suitability of five commercially available, low-cost, portable ultrasound devices that can be combined with future artificial intelligence algorithms to reduce the training required for and cost of in-field optic nerve sheath diameter measurement. This paper is focused on the quality of the images generated by these low-cost probes. We report results of a clinician preference survey and compare with a lab analysis of three quantitative image quality metrics across devices. We also examine the suitability of the devices in a hypothetical far-forward deployment using operators unskilled in ultrasound, with the assumption of a future onboard AI video interpreter. RESULTS We find statistically significant differences in clinician ranking of the devices in the following categories: "Image Quality", "Ease of Acquisition", "Software", and "Overall ONSD". We show differences in signal-to-noise ratio, generalized contrast-to-noise ratio, point-spread function across the devices. These differences in image quality result in a statistically significant difference in manual ONSD measurement. Finally, we show that sufficiently wide transducers can capture the optic nerve sheath during blind (no visible B-mode) scans performed by operators unskilled in sonography. CONCLUSIONS Ultrasound of the optic nerve sheath has the potential to be a convenient, non-invasive, point-of-injury or triage measure for elevated intracranial pressure in cases of traumatic brain injury. When transducer width is sufficient, briefly trained operators may obtain video sequences of the optic nerve sheath without guidance. This data suggest that unskilled operators are able to achieve the images needed for AI interpretation. However, we also show that image quality differences between ultrasound probes may influence manual ONSD measurements.
Collapse
Affiliation(s)
- Brad T Moore
- Medical Computing, Kitware, Inc, Carrboro, NC, USA.
| | - Tom Osika
- Medical Computing, Kitware, Inc, Carrboro, NC, USA
| | - Steven Satterly
- Surgical Critical Care, Duke University Health System, Durham, NC, USA
| | - Shreyansh Shah
- Trauma, Acute, and Critical Care Surgery, Duke University Health System, Durham, NC, USA
| | - Tim Thirion
- Medical Computing, Kitware, Inc, Carrboro, NC, USA
| | | | | | - Sean Montgomery
- Neurocritical Care, Duke University Health System, Durham, NC, USA
| |
Collapse
|
19
|
Chang CWJ, Provencio JJ, Pascual J, Heavner MS, Olson D, Livesay SL, Kaplan LJ. State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist. Crit Care Med 2023; 51:948-963. [PMID: 37070819 DOI: 10.1097/ccm.0000000000005893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer. STUDY SELECTION Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication. DATA EXTRACTION Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice. DATA SYNTHESIS Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer. CONCLUSIONS Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.
Collapse
Affiliation(s)
| | | | - Jose Pascual
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mojdeh S Heavner
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - DaiWai Olson
- Departments of Neurology and Neurosurgery, University of Texas Southwestern, Dallas, TX
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
20
|
Vélez Cevallos A, Vásquez AM. Alterations in the optic nerve and retina in patients with COVID-19. A theoretical review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00110-X. [PMID: 37369321 PMCID: PMC10290763 DOI: 10.1016/j.oftale.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023]
Abstract
The objective of this research is to identify and systematize the medical conditions generated by SARS-CoV-2 on the optic nerve and retina of young, adult, and elderly adults who suffered from COVID-19 in the period 2019-2022. A theoretical documentary review (TDR) was conducted within the framework of an investigation to determine the current state of knowledge of the subject under study. The TDR includes the analysis of publications in the scientific databases PubMed/Medline, Ebsco, Scielo and Google. A total of 167 articles were found, of which 56 were studied in depth, and these evidence the impact of COVID-19 infection on the retina and optic nerve of infected patients, both during the acute phase and in subsequent recovery. Among the reported findings, the following stand out: anterior and posterior non-arteritic ischemic optic neuropathy, optic neuritis, central or branch vascular occlusion, paracentral acute medial maculopathy, neuroretinitis, as well as concomitant diagnoses such as possible Vogt-Koyanagi-Harada disease, multiple evanescent white dot syndrome (MEWDS), Purtscher-like retinopathy, among others.
Collapse
Affiliation(s)
| | - A M Vásquez
- Instituto de Oftalmología y Glaucoma Vásquez
| |
Collapse
|
21
|
Marzola F, Lochner P, Naldi A, Lemor R, Stögbauer J, Meiburger KM. Development of a Deep Learning-Based System for Optic Nerve Characterization in Transorbital Ultrasound Images on a Multicenter Data Set. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00169-2. [PMID: 37357081 DOI: 10.1016/j.ultrasmedbio.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Characterization of the optic nerve through measurement of optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) using transorbital sonography (TOS) has proven to be a useful tool for the evaluation of intracranial pressure (ICP) and multiple neurological conditions. We describe a deep learning-based system for automatic characterization of the optic nerve from B-mode TOS images by automatic measurement of the OND and ONSD. In addition, we determine how the signal-to-noise ratio in two different areas of the image influences system performance. METHODS A UNet was trained as the segmentation model. The training was performed on a multidevice, multicenter data set of 464 TOS images from 110 subjects. Fivefold cross-validation was performed, and the training process was repeated eight times. The final prediction was made as an ensemble of the predictions of the eight single models. Automatic OND and ONSD measurements were compared with the manual measurements taken by an expert with a graphical user interface that mimics a clinical setting. RESULTS A Dice score of 0.719 ± 0.139 was obtained on the whole data set merging the test folds. Pearson's correlation was 0.69 for both OND and ONSD parameters. The signal-to-noise ratio was found to influence segmentation performance, but no clear correlation with diameter measurement performance was determined. CONCLUSION The developed system has a good correlation with manual measurements, proving that it is feasible to create a model capable of automatically analyzing TOS images from multiple devices. The promising results encourage further definition of a standard protocol for the automatization of the OND and ONSD measurement process using deep learning-based methods. The image data and the manual measurements used in this work will be available at 10.17632/kw8gvp8m8x.1.
Collapse
Affiliation(s)
- Francesco Marzola
- Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy.
| | | | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Robert Lemor
- Department of Biomedical Engineering, Saarland University of Applied Sciences, Saarbrücken, Germany
| | | | - Kristen M Meiburger
- Biolab, Department of Electronics and Communications, Politecnico di Torino, Torino, Italy
| |
Collapse
|
22
|
He C, Teng C, Xiong Z, Lin X, Li H, Li X. Intracranial pressure monitoring in neurosurgery: the present situation and prospects. Chin Neurosurg J 2023; 9:14. [PMID: 37170383 PMCID: PMC10176793 DOI: 10.1186/s41016-023-00327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Intracranial pressure (ICP) is one of the most important indexes in neurosurgery. It is essential for doctors to determine the numeric value and changes of ICP, whether before or after an operation. Although external ventricular drainage (EVD) is the gold standard for monitoring ICP, more and more novel monitoring methods are being applied clinically.Invasive wired ICP monitoring is still the most commonly used in practice. Meanwhile, with the rise and development of various novel technologies, non-invasive types and invasive wireless types are gradually being used clinically or in the testing phase, as a complimentary approach of ICP management. By choosing appropriate monitoring methods, clinical neurosurgeons are able to obtain ICP values safely and effectively under particular conditions.This article introduces diverse monitoring methods and compares the advantages and disadvantages of different monitoring methods. Moreover, this review may enable clinical neurosurgeons to have a broader view of ICP monitoring.
Collapse
Affiliation(s)
- Chenqi He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Chubei Teng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Department of Neurosurgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Zujian Xiong
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Xuelei Lin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Hongbo Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
| |
Collapse
|
23
|
Valencia JA, Fabregas N, Tercero J, Valero R. Assessment of cerebral blood flow velocities, brain midline shift and optic nerve sheath diameter by ultrasound in patients undergoing elective craniotomy: A prospective observational feasibility study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:269-275. [PMID: 37150439 DOI: 10.1016/j.redare.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/16/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Brain ultrasound allows measuring the cerebral flow velocity, brain midline shift and optic nerve sheath diameter. Literature is scarce in determining the feasibility to perioperatively perform these measurements altogether and the cerebrovascular behavior in patients scheduled for elective craniotomy. METHODS We assessed bilateral cerebral flow velocities, composite index, brain midline shift and optic nerve sheath diameter by cerebral ultrasound in patients scheduled for elective craniotomy before anesthetic induction, at extubation, and at 6 and 24 h after. The aim was to assess the feasibility of brain ultrasound in patients for elective craniotomy and to describe the changes in cerebral flow velocities, brain midline shift and optic nerve sheath diameter from baseline values at different times in the postoperative period. RESULTS Sixteen patients were included, of these two were excluded from analysis due to an inadequate sonographic window. There were no changes throughout the study regarding cerebral flow velocity, brain midline shift nor optic nerve sheath diameter assessments. All parameters were maintained in the physiological range without significant variations during the procedure. No perioperative complications were detected. CONCLUSIONS The results of our study show the feasibility to perform a perioperative assessment of cerebral flow velocity, brain midline shift or optic nerve sheath diameter jointly and successfully to obtain additional information of baseline cerebral hemodynamics in patients scheduled for elective craniotomy and their postoperative changes during the first 24 h. Future studies with lager samples are needed to address the efficacy of cerebral ultrasound as a monitoring tool.
Collapse
Affiliation(s)
- J A Valencia
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - N Fabregas
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Tercero
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - R Valero
- Sección Neuroanestesia, Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
24
|
Copcuoglu Z, Oruc OA. Diagnostic Accuracy of Optic Nerve Sheath Diameter Measured With Ocular Ultrasonography in Acute Attack of Chronic Obstructive Pulmonary Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:989-995. [PMID: 36149357 DOI: 10.1002/jum.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study aimed to evaluate intracranial pressure changes by measuring ONSD before and after treatment in patients with chronic obstructive pulmonary disease (COPD). METHODS The study was designed as a prospective analysis, in which 56 COPD in acute exacerbation and 50 volunteers. COPD severity was determined by the Dyspnea Scale of Modified Medical Research Council (mMRC). Measurements were made with ocular ultrasonography and linear probe in both eyes. RESULTS Both the right and left ONSDs were higher in the patient compared to the control (P = .017) and regressed after the treatment (P = .021). In the ROC analysis for the predictability of COPD, right eye ONSDs showed a predictive potential for COPD with %75.7 specificity and %68.1 sensitivity at 0.455 cut-off (AUC: 0.727; P = .0001; %95CI: 0.609-0.833). Similar to the right eye, the left ONSD presented %74.4 specificity and %67 sensitivity at 0.505 cut-off value (AUC: 0.718; P = .0001; %95CI: 0.608-0.841). CONCLUSION The ONSD measurement that was with the help of ocular ultrasonography can be a useful diagnostic tool for symptomatic COPD presenting with an acute attack.
Collapse
Affiliation(s)
- Zeliha Copcuoglu
- Department of Emergency Medicine, Ministry of Health, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Oya Akpinar Oruc
- Department of Emergency Medicine, School of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| |
Collapse
|
25
|
Robba C, Battaglini D, Rasulo F, Lobo FA, Matta B. The importance of monitoring cerebral oxygenation in non brain injured patients. J Clin Monit Comput 2023:10.1007/s10877-023-01002-8. [PMID: 37043157 PMCID: PMC10091334 DOI: 10.1007/s10877-023-01002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. While there are many neuromonitoring modalities utilized in brain injured patients, the majority of those are either invasive such as intracranial pressure monitoring, require special skill such as transcranial Doppler ultrasonography, or intermittent such as pupillometry and therefore unable to provide continuous monitoring. Cerebral oximetry using Near infrared Spectroscopy, is a simple non invasive continuous measure of cerebral oxygenation that has been shown to be useful in preventing cerebral hypoxemia both within the intensive care unit and the perioperative settings. At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population.
Collapse
Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy.
- Department of Surgical Science and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesco Rasulo
- Department of Anesthesia and Intensive Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Francisco A Lobo
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Basil Matta
- Neurocritical Care Unit, Cambridge University Hospitals, Cambridge, UK
| |
Collapse
|
26
|
Raffaele A, Giacomo B, Beatrice BLM, Luca AR, Francesco T, Diego M, Giorgio P, Luigi V, Guerino BD. Magnetic Resonance-Based Assessment of Optic Nerve Sheath Diameter: A Prospective Observational Cohort Study on Inter- and Intra-Rater Agreement. J Clin Med 2023; 12:jcm12072713. [PMID: 37048796 PMCID: PMC10095459 DOI: 10.3390/jcm12072713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The measurement of optic nerve sheath diameter (ONSD) as a non-invasive method of estimating intracranial pressure has been widely reported in the literature. However, few studies have evaluated the accuracy of magnetic resonance imaging (MRI) in assessing ONSD measurements, although it is considered a very reliable method, it is not easily repeatable, expensive and is not readily available bedside. Herein, an assessment of the intra- and inter-rater reliability of ONSD assessment using MRI was conducted. METHODS A consecutive, prospective cohort of patients with suspected idiopathic normal-pressure hydrocephalus was analyzed. ONSD MRI measurements of the transverse and sagittal diameters at a distance of 3 mm behind the papilla were evaluated twice each by two expert neuroradiologists. The correlations between MRI examiners were calculated using the concordance correlation coefficient (CCC). RESULTS Fifty patients were included in the study. ONSD MRI average measurements were substantially higher than clinically expected (>5 mm). Considering intra-rater concordance, only one of the two neuroradiologists achieved an excellent score at CCC. Only a moderate inter-observer CCC for MRI assessment was found at all diameters. CONCLUSIONS The use of a widespread MRI sequence (3D T1) to measure ONSD is not an accurate method since it may overestimate measurements and is dependent upon an operator.
Collapse
Affiliation(s)
- Aspide Raffaele
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Neurointensive Care Unit, 40139 Bologna, Italy
| | - Bertolini Giacomo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | | | - Albini Riccioli Luca
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neuroradiology Unit, 40139 Bologna, Italy
| | - Toni Francesco
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neuroradiology Unit, 40139 Bologna, Italy
| | - Mazzatenta Diego
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurosurgery, 40139 Bologna, Italy
| | - Palandri Giorgio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurosurgery, 40139 Bologna, Italy
| | - Vetrugno Luigi
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, 65127 Chieti, Italy
| | - Biasucci Daniele Guerino
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University of Rome, 00133 Rome, Italy
| |
Collapse
|
27
|
Yu ZY, Xing YQ, Li C, Wang SB, Song XN, Wang CC, Wang LJ. Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure. Front Physiol 2023; 14:957758. [PMID: 36969579 PMCID: PMC10036414 DOI: 10.3389/fphys.2023.957758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Background/aim: Patients with elevated intracranial pressure (ICP) tend to have optic disc edema and a thicker optic nerve sheath diameter (ONSD). However, the cut-off value of the optic disc height (ODH) for evaluating elevated ICP is not clear. This study was conducted to evaluate ultrasonic ODH and to investigate the reliability of ODH and ONSD for elevated ICP.Methods: Patients suspected of having increased ICP and who underwent a lumbar puncture were recruited. ODH and ONSD were measured before lumbar puncture. Patients were divided according to elevated and normal ICP. We analyzed the correlations between ODH, ONSD, and ICP. ODH and ONSD cut-off points for the identification of elevated ICP were determined and compared.Results: There were a total of 107 patients recruited for this study, 55 patients with elevated ICP and 52 with normal ICP. Both ODH and ONSD in the elevated ICP group were higher than in the normal group [ODH: median 0.81 (range 0.60–1.06) mm vs. 0.40 [0–0.60] mm, p < 0.001; ONSD: 5.01 ± 0.37 mm vs. 4.20 ± 0.38 mm, p < 0.001]. ICP was positively correlated with ODH (r = 0.613; p < 0.001) and ONSD (r = 0.792; p < 0.001). The cut-off values of ODH and ONSD for evaluating elevated ICP were 0.63 mm and 4.68 mm, respectively, with 73% and 84% sensitivity and 83% and 94% specificity, respectively. ODH combined with ONSD showed the highest value under the receiver operating characteristic curve of 0.965 with a sensitivity of 93% and a specificity of 92%.Conclusion: Ultrasonic ODH combined with ONSD may help monitor elevated ICP non-invasively.
Collapse
Affiliation(s)
- Ze-yang Yu
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
- Department of Rehabilitation Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Ying-qi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Bejing, China
| | - Cong Li
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
| | - Si-bo Wang
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
| | - Xiao-nan Song
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
| | - Cui-cui Wang
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
| | - Li-juan Wang
- Department of Neurology, The First Hospiatal of Jilin University, Changchun, China
- *Correspondence: Li-juan Wang,
| |
Collapse
|
28
|
Roemer SN, Friedrich EB, Kettner M, Rauzi M, Schub P, Kulikovski J, Janitschke D, Stögbauer J, Lochner P. Transorbital sonography and MRI reliability to assess optic nerve sheath diameter in idiopathic intracranial hypertension. J Neuroimaging 2023; 33:375-380. [PMID: 36859645 DOI: 10.1111/jon.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the performance of magnetic resonance imaging (MRI) in measuring the optic nerve sheath diameter (ONSD) compared to the established method transorbital sonography (TOS) in patients with idiopathic intracranial hypertension (IIH). METHODS Twenty-three patients with IIH were prospectively included applying IIH diagnostic criteria. All patients received a lumbar puncture with assessment of the cerebrospinal fluid (CSF) opening pressure to assure the IIH diagnosis. Measurement of ONSD was performed 3 mm posterior to inner sclera surface in B-TOS by an expert examiner, while three independent neuroradiologists took measurements in axial T-weighted MRI examinations. The sella turcica with the pituitary gland (and potential presence of an empty sella) and the trigeminal cavity were also assessed on sagittal and transversal T1-weighted MRI images by one independent neuroradiologist. RESULTS The means of ONSD between ultrasound and MRI measurements were 6.3 mm (standard deviation [SD] = 0.6 mm) and 6.2 mm (SD = 0.8 mm). The interrater reliability between three neuroradiologists showed a high interclass correlation coefficient (ICC) (confidence interval: .573 < ICC < .8; p < .001). In patients with an empty sella, the ONSD evaluated by MRI was 6.6 mm, while measuring 6.1 mm in patients without empty sella. No correlation between CSF opening pressure and ONSD was found. CONCLUSIONS MRI can reliably measure ONSD and yields similar results compared to TOS in patients with IIH. Moreover, patients with empty sella showed significantly larger ONSD than patients without empty sella.
Collapse
Affiliation(s)
- Sebastian Niclas Roemer
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | | | - Michael Kettner
- Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany
| | - Martina Rauzi
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Peter Schub
- Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany
| | - Johann Kulikovski
- Department of Neuroradiology, Saarland University Medical Center, Homburg, Germany
| | - Daniel Janitschke
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Jakob Stögbauer
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
29
|
Wolthers SA, Engelholm CP, Uslu B, Brandt CT. Noninvasive intracranial pressure monitoring in central nervous system infections. Minerva Anestesiol 2023; 89:206-216. [PMID: 36422116 DOI: 10.23736/s0375-9393.22.16863-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intracranial pressure (ICP) monitoring constitutes an important part of the management of traumatic brain injury. However, its application in other brain pathologies such as neuroinfections like acute bacterial meningitis is unclear. Despite focus on aggressive, prompt treatment, morbidity and mortality from acute bacterial meningitis remain high. Increased ICP is well-known to occur in severe neuroinfections. The increased ICP compromise cerebral perfusion pressure and may ultimately lead to brain stem herniation. Therefore, controlling the ICP could also be important in acute bacterial meningitis. However, risk factors for complications due to invasive monitoring among these patients may be significantly increased due to higher age and levels of comorbidity compared to the traumatic brain injury patient from which the ICP treatment algorithms are developed. This narrative review evaluates the different modalities of ICP monitoring with the aim to elucidate current status of non-invasive alternatives to invasive monitoring as a decision tool and eventually monitoring. Non-invasive screening using ultrasound of the optical nerve sheath, transcranial doppler, magnetic resonance imaging or preferably a combination of these modalities, provides measurements that can be used as a decision guidance for invasive ICP measurement. The available data do not support the replacement of invasive techniques for continuous ICP measurement in patients with increased ICP. Non-invasive modalities should be taken into consideration in patients with neuroinfections at low risk of increased ICP.
Collapse
Affiliation(s)
- Signe A Wolthers
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark -
| | - Cecilie P Engelholm
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Bülent Uslu
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Christian T Brandt
- Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| |
Collapse
|
30
|
Gültekin H, Güven M. Optic nerve sheath diameter, intensive care unit admission and COVID-19-related-in-hospital mortality. QJM 2023; 116:107-113. [PMID: 36259936 PMCID: PMC9619847 DOI: 10.1093/qjmed/hcac242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypoxia and hypercapnia due to acute pulmonary failure in patients with coronavirus disease 2019 (COVID-19) can increase the intracranial pressure (ICP). ICP correlated with the optic nerve sheath diameter (ONSD) on ultrasonography and is associated with a poor prognosis. AIM We investigated the capability of ONSD measured during admission to the intensive care unit (ICU) in patients with critical COVID-19 in predicting in-hospital mortality. METHODS A total of 91 patients enrolled in the study were divided into two groups: survivor (n = 48) and nonsurvivor (n = 43) groups. ONSD was measured by ultrasonography within the first 3 h of ICU admission. RESULTS The median ONSD was higher in the nonsurvivor group than in the survivor group (5.95 mm vs. 4.15 mm, P < 0.001). The multivariate Cox proportional hazard regression analysis between ONSD and in-hospital mortality (contains 26 covariates) was significant (adjusted hazard ratio, 4.12; 95% confidence interval, 1.46-11.55; P = 0.007). The ONSD cutoff for predicting mortality during ICU admission was 5 mm (area under the curve, 0.985; sensitivity, 98%; and specificity, 90%). The median survival of patients with ONSD >5 mm (43%; n = 39) was lower than those with ONSD ≤5 mm (57%; n = 52) (11.5 days vs. 13.2 days; log-rank test P = 0.001). CONCLUSIONS ONSD ultrasonography during ICU admission may be an important, cheap and easy-to-apply method that can be used to predict mortality in the early period in patients with critical COVID-19.
Collapse
Affiliation(s)
- Hamza Gültekin
- Şırnak State Hospital, Department of Intensive Care Unit, 73000, Şırnak, Turkey
| | - Mehmet Güven
- Şırnak State Hospital, Department of Endocrinology and Metabolism, 73000, Şırnak, Turkey
| |
Collapse
|
31
|
Lau T, Ahn JS, Manji R, Kim DJ. A Narrative Review of Point of Care Ultrasound Assessment of the Optic Nerve in Emergency Medicine. Life (Basel) 2023; 13:life13020531. [PMID: 36836888 PMCID: PMC9962087 DOI: 10.3390/life13020531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Point of care ultrasound (POCUS) of the optic nerve is easy to learn and has great diagnostic potential. Within emergency medicine, research has primarily focused on its use for the assessment of increased intracranial pressure, but many other applications exist, though the literature is heterogeneous and largely observational. This narrative review describes the principles of POCUS of the optic nerve including anatomy and scanning technique, as well as a summary of its best studied clinical applications of relevance in emergency medicine: increased intracranial pressure, idiopathic intracranial hypertension, optic neuritis, acute mountain sickness, and pediatric intracranial pressure assessment. In many of these applications, sonographic optic nerve sheath diameter (ONSD) has moderately high sensitivity and specificity, but the supporting studies are heterogeneous. Further studies should focus on standardization of the measurement of ONSD, establishment of consistent diagnostic thresholds for elevated intracranial pressure, and automation of ONSD measurement.
Collapse
Affiliation(s)
- Torey Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Justin S. Ahn
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Rahim Manji
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Daniel J. Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- Correspondence: ; Tel.: +1-604-875-4855
| |
Collapse
|
32
|
Yic CD, Pontet J, Mercado M, Muñoz M, Biestro A. Ultrasonographic measurement of the optic nerve sheath diameter to detect intracranial hypertension: an observational study. Ultrasound J 2023; 15:4. [PMID: 36729242 PMCID: PMC9895168 DOI: 10.1186/s13089-022-00304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To evaluate the ultrasonographic measurement of optic nerve sheath diameter (ONSD) as a predictor of intracranial hypertension as compared to the invasive measurement of intracranial pressure (ICP). DESIGN Cross-sectional observational study. SETTING Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay. PATIENTS We included 56 adult patients, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring as a result of a severe acute neurologic injury (traumatic or non-traumatic) and had a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU. INTERVENTIONS Ultrasonographic measurement of ONSD to detect intracranial hypertension. MEASUREMENTS AND MAIN RESULTS In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (< 0.05). This model estimates and predicts the probability that a patient will have an ICP greater than 20 mmHg. From the analysis of the cut-off points, it is observed that a value of 5.7 mm of ONSD maximizes the sensitivity (92.9%) of the method (a greater number of individuals with ICP > 20 mmHg are correctly identified). CONCLUSIONS In sedated neurocritical patients, with structural Acute Brain Injury, the ONSD measurement correlates with the invasive measurement of ICP. It was observed that with ONSD values less than 5.7 mm, the probability of being in the presence of ICP above 20 mmHg is very low, while for ONSD values greater than 5.7 mm, said probability clearly increases.
Collapse
Affiliation(s)
- Christian Daniel Yic
- Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338, Montevideo, Uruguay.
| | - Julio Pontet
- Department of Critical Care Medicine, Hospital Pasteur, Montevideo, Uruguay
| | - Mauricio Mercado
- Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338, Montevideo, Uruguay
| | - Matias Muñoz
- Comisión Honoraria para la salud Cardiovascular, Montevideo, Uruguay
| | - Alberto Biestro
- Department of Critical Care Medicine, Hospital de Clínicas, Asociación Española Primera en Salud, Guillermo Arrospide, 5338, Montevideo, Uruguay
| |
Collapse
|
33
|
Lim H, Kim E, Kim SY, Kim JY, Jung Y, Lee T, Kim N, Tae K. Detection of increased intracranial pressure in trans-oral robotic thyroidectomy using optic nerve sheath diameter measurement. Head Neck 2023; 45:329-336. [PMID: 36333967 DOI: 10.1002/hed.27234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During transoral robot-assisted thyroidectomy, there is a risk of increasing intracranial pressure because the site of CO2 insufflation is narrow and close to the brain. METHODS We analyzed the pre- to post-CO2 neck insufflation change in the optic nerve sheath diameter during transoral robot-assisted thyroidectomy. Changes in vital-signs, airway pressure, and arterial carbon dioxide pressure were analyzed along with postoperative complications. RESULTS Among the 30 participants, the post-CO2 inflation mean optic nerve sheath diameter (5.64 ± 0.54 mm) was higher than the pre-induction diameter (4.81 ± 0.37 mm) with a mean difference of 0.83 (95% CI, 0.69-0.97; p < 0.001), but returned to baseline after CO2 deflation in most cases. One participant had sustained increased optic nerve sheath diameter (6.35 mm) associated with severe new-onset postoperative headache. CONCLUSION Transient elevation in the intracranial pressure during low-pressure CO2 neck insufflation in the transoral robot-assisted thyroidectomy did not appear to adversely affect patients.
Collapse
Affiliation(s)
- Hyunyoung Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ji-Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yundo Jung
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Tagkeun Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Nayeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| |
Collapse
|
34
|
Milan JB, Jensen TSR, Nørager N, Pedersen SSH, Riedel CS, Toft NM, Ammar A, Foroughi M, Grotenhuis A, Perera A, Rekate H, Juhler M. The ASPECT Hydrocephalus System: a non-hierarchical descriptive system for clinical use. Acta Neurochir (Wien) 2023; 165:355-365. [PMID: 36427098 PMCID: PMC9922243 DOI: 10.1007/s00701-022-05412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
In patients with hydrocephalus, prognosis and intervention are based on multiple factors. This includes, but is not limited to, time of onset, patient age, treatment history, and obstruction of cerebrospinal fluid flow. Consequently, several distinct hydrocephalus classification systems exist. The International Classification of Diseases (ICD) is universally applied, but in ICD-10 and the upcoming ICD-11, hydrocephalus diagnoses incorporate only a few factors, and the hydrocephalus diagnoses of the ICD systems are based on different clinical measures. As a consequence, multiple diagnoses can be applied to individual cases. Therefore, similar patients may be described with different diagnoses, while clinically different patients may be diagnosed identically. This causes unnecessary dispersion in hydrocephalus diagnostics, rendering the ICD classification of little use for research and clinical decision-making. This paper critically reviews the ICD systems for scientific and functional limitations in the classification of hydrocephalus and presents a new descriptive system. We propose describing hydrocephalus by a system consisting of six clinical key factors of hydrocephalus: A (anatomy); S (symptomatology); P (previous interventions); E (etiology); C (complications); T (time-onset and current age). The "ASPECT Hydrocephalus System" is a systematic, nuanced, and applicable description of patients with hydrocephalus, with a potential to resolve the major issues of previous classifications, thus providing new opportunities for standardized treatment and research.
Collapse
Affiliation(s)
| | - Thorbjørn Søren Rønn Jensen
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | | | - Sarah Skovlunde Hornshøj Pedersen
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | - Casper Schwartz Riedel
- Copenhagen CSF Study Group, Copenhagen, Denmark
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark
| | | | - Ahmed Ammar
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
| | - Mansoor Foroughi
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Wellington Hospital, London, UK
| | - André Grotenhuis
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, Holland, Netherlands
| | - Andrea Perera
- Department of Basic and Clinical Neuroscience, Kings College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
| | - Harold Rekate
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium
- Department of Neurosurgery, Hofstra Northwell School of Medicine in Hempstead, Hempstead, NY, USA
| | - Marianne Juhler
- Copenhagen CSF Study Group, Copenhagen, Denmark.
- Department of Neurosurgery 6031, Rigshospitalet, Inge Lehmanns Vej 6, Copenhagen, DK 2100, Denmark.
- European Association of Neurosurgical Societies (EANS) CSF Task Force, Brussels, Belgium.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
35
|
Huang S, Lund T, Orchard P, Gupta A, Nascene D. Dilated Optic Nerve Sheath in Mucopolysaccharidosis I: Common and Not Necessarily High Intracranial Pressure. AJNR Am J Neuroradiol 2023; 44:91-94. [PMID: 36581456 PMCID: PMC9835902 DOI: 10.3174/ajnr.a7755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
Hydrocephalus is one of the earliest manifestations of mucopolysaccharidosis I-Hurler syndrome, and delayed treatment of hydrocephalus can lead to neurocognitive delay or even death. Optic nerve sheath diameter has been established as a noninvasive measurement to detect elevated intracranial pressure. This study aimed to establish correlations between optic nerve sheath diameter and opening pressure. Forty-nine MR images and opening pressures in patients with mucopolysaccharidosis I-Hurler syndrome were retrospectively reviewed from 2008 to 2020. The optic nerve sheath diameter was measured 3 mm posterior to the posterior margin of the globe (retrobulbar) and 10 mm anterior to the optic foramen (midpoint segment), and the average was taken between the 2 eyes. Opening pressure was measured with the patient in the lateral decubitus position with controlled end-tidal CO2 on the same day as the MR imaging. The average retrobulbar optic nerve sheath diameter was 5.33 mm, higher than the previously reported measurement in healthy controls, in patients with idiopathic intracranial hypertension, and there was a positive correlation between age and the optic nerve sheath diameter measured at the retrobulbar or midpoint segment (retrobulbar segment, R 2 = 0.27, P < .01; midpoint segment, R 2 = 0.20, P < .01). However, there was no correlation between retrobulbar or midpoint segment optic nerve sheath diameter and opening pressure (retrobulbar segment, R 2 = 0.02, P = .17; midpoint segment, R 2 = 0.03, P < .12). This study shows a higher average optic nerve sheath diameter in patients with mucopolysaccharidosis I-Hurler syndrome than in healthy controls regardless of the location of the measurement. However, the degree of optic nerve sheath dilation does not correlate with opening pressure, suggesting that increased optic nerve sheath diameter is an ocular manifestation of mucopolysaccharidosis I-Hurler syndrome itself rather than a marker of elevated intracranial pressure.
Collapse
Affiliation(s)
- S Huang
- From the Department of Neurosurgery (S.H.)
| | - T Lund
- Division of Pediatric Blood and Marrow Transplant (T.L., P.O., A.G.)
| | - P Orchard
- Division of Pediatric Blood and Marrow Transplant (T.L., P.O., A.G.)
| | - A Gupta
- Division of Pediatric Blood and Marrow Transplant (T.L., P.O., A.G.)
| | - D Nascene
- Department of Radiology (D.N.), University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
36
|
Li C, Wang CC, Meng Y, Fan JY, Zhang J, Wang LJ. Ultrasonic optic nerve sheath diameter could improve the prognosis of acute ischemic stroke in the intensive care unit. Front Pharmacol 2022; 13:1077131. [PMID: 36618944 PMCID: PMC9816399 DOI: 10.3389/fphar.2022.1077131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Stroke patients with high intracranial pressure (ICP) may have poor prognosis. Non-invasive ultrasonic optic nerve sheath diameter (ONSD) could evaluate increased ICP. To investigate whether ONSD is valuable for prognosis of patients with acute ischemic stroke (AIS). Methods: AIS receiving intensive care were recruited with the Glasgow Coma Scale (GCS) score. Patients in group A underwent ultrasonic ONSD to assess ICP voluntarily, whereas group B without ONSD. Patients were followed up at discharge and once a week for 3 months with Glasgow Outcome Scale (GOS) score (four to five scores indicated good prognosis and one to three scores indicated poor prognosis). Results: Forty-nine patients were included. GCS scores did not differ significantly between groups A (26 patients) and B (8 ± 3 vs. 7 ± 3, p < 0.05). In group A, ONSD was 5.01 ± 0.48 mm, which correlated with GCS score (p < 0.05). At discharge, the GOS score was higher in group A than in group B (3.35 ± 1.35 vs. 2.57 ± 1.121, p = 0.034). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 13.0%, p = 0.006). At discharge and after 3 months of follow-up, ONSD at admission was correlated with the GOS score in group A (r = -0.648 [p < 0.05] and -0.731 [p < 0.05], respectively). After 3 months of follow-up, the GOS score was higher in group A than group B (3.00 ± 1.673 vs. 2.04 ± 1.430, p < 0.05). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 21.2%, p = 0.039). The Kaplan-Meier curve showed a higher rate of good prognosis in group A than in group B. ONSD (p < 0.05) was an independent predictor of poor prognosis. Conclusion: Non-invasive ultrasonic ONSD could be useful in improving the prognosis of patients with AIS receiving intensive care.
Collapse
Affiliation(s)
- Cong Li
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Cui-Cui Wang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China,Department of Rehabilitation, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yan Meng
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Jia-Yu Fan
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Jie Zhang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China,*Correspondence: Li-Juan Wang,
| |
Collapse
|
37
|
Rodríguez Aparicio EE, Carrizosa Gonzalez JA, Rodriguez Lima DR. Optic nerve sheath diameter at high altitude: standardized measures in healthy volunteers. Ultrasound J 2022; 14:46. [PMCID: PMC9674817 DOI: 10.1186/s13089-022-00295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Increases in the diameter of the optic nerve sheath (ONSD) on ultrasound are associated with high intracranial pressure (hICP). The normal value varies with altitude and the population studied. The objective of this study is to describe the normal values of the ONSD in a healthy adult population of the city of Bogotá, Colombia, at 2640 meters above sea level (masl). Patients and methods A prospective observational study was conducted on a total of 247 healthy individuals recruited from May 2021 to May 2022 who were subjected to the color, low power, optic disk, safety, elevated frequency, dual (CLOSED) protocol for measuring the bilateral ONSD adjusted to the eyeball transverse diameter (ETD). Results A total of 230 individuals were analyzed; the average ONSD of the right eye (RE) was 0.449 cm (range 0.288–0.7) and that of the left eye (LE) was 0.454 cm (range 0.285–0.698); the correlation between RE and LE was 0.93 (p < 0.005), and the correlation of the ONSD/ETD ratios for the RE and LE was lower (r2 = 0.79, p < 0.005). A total of 10.8% of the studied population had values greater than 0.55 cm. Conclusions The median ONSD and ONSD/ETD ratio in the city of Bogotá are similar to those described in other populations; however, approximately 10.8% of the healthy population may present higher values, which would limit the use of ONSD on its own for clinical decision-making, only repeated measurements with significant changes in the ONSD and ONSD/ETD or asymmetries between the measurements of both eyes linked to clinical findings would allow the diagnosis of hICP.
Collapse
Affiliation(s)
- Edith Elianna Rodríguez Aparicio
- grid.418089.c0000 0004 0620 2607Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Faculty of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jorge Armando Carrizosa Gonzalez
- grid.418089.c0000 0004 0620 2607Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David Rene Rodriguez Lima
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Mederi, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
38
|
Aspide R, Bertolini G, Belotti LMB, Albini Riccioli L, Toni F, Mazzatenta D, Palandri G, Vetrugno L, Biasucci DG. The CLOSED protocol to assess optic nerve sheath diameter using color-Doppler: a comparison study in a cohort of idiopathic normal pressure hydrocephalus patients. Ultrasound J 2022; 14:43. [PMID: 36309606 DOI: 10.1186/s13089-022-00291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sonographic assessment of the optic nerve sheath diameter represents a promising non-invasive technique for estimation of the intracranial pressure. A wide inter-observer variability, along with a lack of a standardized protocol for the optic nerve sheath diameter measurements, could lead to over- or under-estimation. The present study was aimed at evaluating feasibility of color-Doppler for better delineating optic nerve sheath borders, comparing it to B-mode imaging, using the magnetic resonance measurements as a comparison. METHODS Optic nerve sheath diameters were evaluated using magnetic resonance by an expert radiologist in a cohort of patients with suspected idiopathic normal pressure hydrocephalus. Magnetic resonance findings were evaluated twice. In the first half of this cohort, optic nerve sheath diameters were measured using B-mode only, in the second half applying color-Doppler. Measurements obtained using these two techniques were compared to magnetic resonance imaging measurements. The Bland-Altman analysis and concordance correlation coefficient were computed to quantify the strength of agreement between the two magnetic resonance assessments. Box plots and average (± SD) were used to compare assessments by sonographic and magnetic resonance methods. RESULTS Fifty patients were included. MRI assessment showed a moderate concordance correlation coefficient. Optic nerve sheath diameters measured applying color-Doppler were lower (p < 0.001) and less scattered compared to B-mode assessment, which approached more to magnetic resonance measurements. CONCLUSIONS In this cohort of patients, magnetic resonance showed high intra-rater variability in optic nerve sheath diameter assessments. Optic nerve sheath diameter assessments using color-Doppler yielded lower and less scattered diameters compared to B-mode only.
Collapse
Affiliation(s)
- Raffaele Aspide
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Neurointensive Care Unit, Bologna, Italy.
| | - Giacomo Bertolini
- Department of Biomedical and Neuromotor Sciences, Department of Neurosurgery, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Department of Neurosurgery, Bologna, Italy
| | | | - Luca Albini Riccioli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bologna, Italy
| | - Francesco Toni
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences, Department of Neurosurgery, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Department of Neurosurgery, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Department of Neurosurgery, Bologna, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Guerino Biasucci
- "Tor Vergata" University of Rome, Department of Clinical Science and Translational Medicine, Rome, Italy
| |
Collapse
|
39
|
Optic nerve sheath diameter is associated with outcome in severe Covid-19. Sci Rep 2022; 12:17255. [PMID: 36241671 PMCID: PMC9568587 DOI: 10.1038/s41598-022-21311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023] Open
Abstract
Neurological symptoms are common in Covid-19 and cerebral edema has been shown post-mortem. The mechanism behind this is unclear. Elevated intracranial pressure (ICP) has not been extensively studied in Covid-19. ICP can be estimated noninvasively with measurements of the optic nerve sheath diameter (ONSD). We performed a cohort study with ONSD ultrasound measurements in severe cases of Covid-19 at an intensive care unit (ICU). We measured ONSD with ultrasound in adults with severe Covid-19 in the ICU at Karolinska University Hospital in Sweden. Patients were classified as either having normal or elevated ONSD. We compared ICU length of stay (ICU-LOS) and 90 day mortality between the groups. 54 patients were included. 11 of these (20.4%) had elevated ONSD. Patients with elevated ONSD had 12 days longer ICU-LOS (95% CI 2 to 23 p = 0.03) and a risk ratio of 2.3 for ICU-LOS ≥ 30 days. There were no significant differences in baseline data or 90 day mortality between the groups. Elevated ONSD is common in severe Covid-19 and is associated with adverse outcome. This may be caused by elevated ICP. This is a clinically important finding that needs to be considered when deciding upon various treatment strategies.
Collapse
|
40
|
Fall DA, Lee AG, Bershad EM, Kramer LA, Mader TH, Clark JB, Hirzallah MI. Optic nerve sheath diameter and spaceflight: defining shortcomings and future directions. NPJ Microgravity 2022; 8:42. [PMID: 36202836 PMCID: PMC9537149 DOI: 10.1038/s41526-022-00228-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
Neuro-ocular changes during long-duration space flight are known as spaceflight-associated neuro-ocular syndrome (SANS). The ability to detect, monitor, and prevent SANS is a priority of current space medicine research efforts. Optic nerve sheath diameter (ONSD) measurement has been used both terrestrially and in microgravity as a proxy for measurements of elevated intracranial pressure. ONSD shows promise as a potential method of identifying and quantitating neuro-ocular changes during space flight. This review examines 13 studies measuring ONSD and its relationship to microgravity exposure or ground-based analogs, including head-down tilt, dry immersion, or animal models. The goal of this correspondence is to describe heterogeneity in the use of ONSD in the current SANS literature and make recommendations to reduce heterogeneity in future studies through standardization of imaging modalities, measurement techniques, and other aspects of study design.
Collapse
Affiliation(s)
- Dylan A Fall
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.,Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, USA.,Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA.,Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Texas A and M College of Medicine, Bryan, TX, USA
| | - Eric M Bershad
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA.,Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Larry A Kramer
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, USA
| | | | - Jonathan B Clark
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA
| | - Mohammad I Hirzallah
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA. .,Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
41
|
Pansell J, Hack R, Rudberg P, Bell M, Cooray C. Can Quantitative Pupillometry be used to Screen for Elevated Intracranial Pressure? A Retrospective Cohort Study. Neurocrit Care 2022; 37:531-537. [PMID: 35606562 PMCID: PMC9519702 DOI: 10.1007/s12028-022-01518-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Elevated intracranial pressure (ICP) is a serious complication in brain injury. Because of the risks involved, ICP is not monitored in all patients at risk. Noninvasive screening tools to identify patients with elevated ICP are needed. Anisocoria, abnormal pupillary size, and abnormal pupillary light reflex are signs of high ICP, but manual pupillometry is arbitrary and subject to interrater variability. We have evaluated quantitative pupillometry as a screening tool for elevated ICP. METHODS We performed a retrospective observational study of the association between Neurological Pupil index (NPi), measured with the Neuroptics NPi-200 pupillometer, and ICP in patients routinely monitored with invasive ICP measurement in the intensive care unit. We performed a nonparametric receiver operator curve analysis for ICP ≥ 20 mm Hg with NPi as a classification variable. We performed a Youden analysis for the optimal NPi cutoff value and recorded sensitivity and specificity for this cutoff value. We also performed a logistic regression with elevated ICP as the dependent variable and NPi as the independent variable. RESULTS We included 65 patients with invasive ICP monitoring. A total of 2,705 measurements were analyzed. Using NPi as a screening tool for elevated ICP yielded an area under receiver operator curve of 0.72. The optimal mean NPi cutoff value to rule out elevated ICP was ≥ 3.9. The probability of elevated ICP decreased with increasing NPi, with an odds ratio of 0.55 (0.50, 0.61). CONCLUSIONS Screening with NPi may inform high stakes clinical decisions by ruling out elevated ICP with a high degree of certainty. It may also aid in estimating probabilities of elevated ICP. This can help to weigh the risks of initiating invasive ICP monitoring against the risks of not doing so. Because of its ease of use and excellent interrater reliability, we suggest further studies of NPi as a screening tool for elevated ICP.
Collapse
Affiliation(s)
- Jakob Pansell
- Department of Clinical Neuroscience, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden.
- Department of Anesthesia and Intensive Care Medicine, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden.
| | - Robert Hack
- Department of Anesthesia and Intensive Care Medicine, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden
| | - Peter Rudberg
- Department of Anesthesia and Intensive Care Medicine, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Max Bell
- Department of Anesthesia and Intensive Care Medicine, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institutet, Central Intensive Care Unit E5:67, Karolinska University Hospital, Stockholm, 17176, Sweden
- The Department of Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
42
|
Akyüz ME, Kadıoğlu HH. Evaluation of third ventriculostomy outcome by measuring optic nerve sheath diameter in adult hdyrocephalus. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:176-181. [PMID: 35725218 DOI: 10.1016/j.neucie.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE It is difficult to demonstrate the success of the procedure in patients with third ventriculostomy. We evaluated that optic nerve sheath diameter (ONSD) measurement, which can reflect intracranial pressure, may be a criterion for decision of endoscopic third ventriculostomy (ETV) success. METHODS 28 adult patients suffering long overt standing ventriculomegaly (LOVA) who performed ETV were included in this retrospective study. The patients were divided into two groups as successful (group A) and failed ETV group (group B) according to their postoperative evaluation. ONSD was measured on pre- and post-operative computed tomography (CT) and Evan's index (EI), diameter of third ventricule (V3), the patency of ETV stoma and periventricular edema were evaluated by magnetic resonance imaging (MRI). RESULTS The mean ONSD was measured as 6.39±0.92mm for the right eye, 6.50±0.91mm for the left eye on preoperative CT. The mean ONSD by CT (after surgery) was 4.89±0.87mm for the right eye, 5.02±0.1mm for the left eye (p<0.05). Postoperative group A and group B were compared according to ONSD measurement; mean ONSD in group A was 4.52±0.69mm for the right and 4.59±0.9mm for the left, mean ONSD in group B was 5.82±0.51mm for the right and 6.1±0.32mm for the left (p<0.05). The best ONSD value for detecting failed ETV was 5.40mm (sensitivity 90%, specifity 75%, AUROC 0.938) for right and 5.91mm (sensitivity 90%, specifity 75%, AUROC 0.950) for left. EE was measured as 0.39±0.12mm on preoperative MRI and 0.39±0.12mm on postoperative MRI (p=0.3). V3 was measured as 14.7±2.47mm on preoperative MRI and 10.47±1.99mm on postoperative MRI (p<0.05). CONCLUSION The statistical values obtained from study show that the ONSD measurement can help in the postoperative evaluation of patients, who had a ETV surgery.
Collapse
Affiliation(s)
- Mehmet Emin Akyüz
- Siirt Training and Research Hospital, Neurosurgery Depertmant, Siirt, Turkey.
| | - Hakan Hadi Kadıoğlu
- Ataturk University, Faculty of Medicine, Neurosurgery Depertmant, Erzurum, Turkey
| |
Collapse
|
43
|
Hirzallah MI, Lochner P, Hafeez MU, Lee AG, Krogias C, Dongarwar D, Manchanda R, Ouellette L, Hartman ND, Ertl M, Schlachetzki F, Robba C. Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol. J Neuroimaging 2022; 32:808-824. [PMID: 35711135 DOI: 10.1111/jon.13018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC). METHODS A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript. RESULTS A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement. CONCLUSIONS This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine.
Collapse
Affiliation(s)
- Mohammad I Hirzallah
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.,Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA.,Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Christos Krogias
- Department of Neurology, St Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Deepa Dongarwar
- Institutional Diversity & Student Services, Baylor College of Medicine, Houston, Texas, USA
| | - Ramneek Manchanda
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Nicholas D Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Regensburg, Germany
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, Policlinico San Martino, Genova, Italy
| |
Collapse
|
44
|
Dağdelen K, Ekici M. Measuring optic nerve sheath diameter using ultrasonography in patients with idiopathic intracranial hypertension. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:580-585. [PMID: 35613208 PMCID: PMC9387182 DOI: 10.1590/0004-282x-anp-2021-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/13/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is primarily a disorder of obese young women characterized by symptoms associated with raised intracranial pressure in the absence of a space-occupying lesion. OBJECTIVE To compare the mean optic nerve sheath diameter (ONSD) measured using ultrasonography (USG) in patients with idiopathic intracranial hypertension (IIH) and normal healthy individuals. METHODS A prospective study. Ninety-seven participants aged 18-80 years were divided into two groups as patients with IIH (n=47) and the control group (n=50). The ONSD was measured using ultrasound with a 10-MHz probe. ONSD was measured 3 mm behind the optic disc. Receiver operating characteristic (ROC) curve analysis was performed to determine patients with IIH using ONSD. RESULTS Body mass index was higher in the IIH group compared with the control group (p=0.001). The mean ONSD was statistically significantly thicker in the IIH group (6.4 mm) than in the control group (4.90 mm). The cut-off value of ONSD in patients with IIH was measured as 5.70 mm. There was a significant negative correlation between ONSD and age (r:-0.416 and p<0.001). There was a positive correlation between BMI and ONSD (r: 0.437 and p<0.001). CONCLUSIONS Ultrasound can be a reliable, non-invasive and rapid tool to measure ONSD in monitoring patients with IIH. After the first diagnosis of IIH, based on neuroimaging and measuring intracranial pressure using invasive methods, ONSD can be used in treatment and follow-up.
Collapse
Affiliation(s)
- Kenan Dağdelen
- Beytepe Murat Erdi Eker State Hospital, Department of Ophthalmology, Çankaya, Ankara, Turkey
| | - Merve Ekici
- Beytepe Murat Erdi Eker State Hospital, Department of Neurology, Çankaya, Ankara, Turkey
| |
Collapse
|
45
|
Robba C. Measuring optic nerve sheath diameter using ultrasonography for the detection of non invasive intracranial pressure: what it is and what it is not. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:547-549. [PMID: 35946717 PMCID: PMC9387181 DOI: 10.1590/0004-282x-anp-2022-e006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Chiara Robba
- San Martino Policlinico Hospital, Anesthesia and Critical Care, IRCCS for Oncology and Neuroscience, Genoa, Italy
- University of Genoa, Department of Surgical Sciences and Integrated Diagnostics, Genoa, Italy
| |
Collapse
|
46
|
Mao JY, Zhang HM, Liu DW, Wang XT. Visual Rounds Based on Multiorgan Point-of-Care Ultrasound in the ICU. Front Med (Lausanne) 2022; 9:869958. [PMID: 35692540 PMCID: PMC9174546 DOI: 10.3389/fmed.2022.869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is performed by a treating clinician at the patient's bedside, provides a acquisition, interpretation, and immediate clinical integration based on ultrasonographic imaging. The use of POCUS is not limited to one specialty, protocol, or organ system. POCUS provides the treating clinician with real-time diagnostic and monitoring information. Visual rounds based on multiorgan POCUS act as an initiative to improve clinical practice in the Intensive Care Unit and are urgently needed as part of routine clinical practice.
Collapse
Affiliation(s)
- Jia-Yu Mao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Ting Wang
| |
Collapse
|
47
|
Urbonas M, Raskauskiene N, Deltuva V, Bunevicius A. Quantitative Evans index estimation using ultrasonographic measurement of the optic nerve sheath diameter in supine and upright position. Acta Neurochir (Wien) 2022; 164:1755-1764. [PMID: 35595855 DOI: 10.1007/s00701-022-05234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to quantitatively assess Evans index (EI) using ultrasonographic optic nerve sheath diameter (ONSD) measurements in supine and upright position in normal pressure hydrocephalus (NPH) patients. METHODS Ultrasonographically ONSD was measured in a supine and upright position before and 4-5 days after the ventriculoperitoneal shunt surgery. The changes of the ONSD between supine and upright positions were calculated as ∆ONSD = sONSD-uONSD and as the variation ONSD_V = 100% × [(sONSD - uONSD)/sONSD]. Multiple linear regression analyses were conducted to assess associations between EI and the variation of ONSD. We derived the mathematical function to predict EI. Bland-Altman analysis was applied to evaluate the accuracy and precision of the EI prediction. RESULTS Thirteen adult patients (mean age 61.8 ± 11.1 (SD) years; 6 (46%) female) undergone VP shunt implantation for NPH. The mean EI was 0.432 (95% CI, 0.393-0.471) preoperatively and 0.419 (95% CI, 0.373-0.466) postoperatively (p = 0.066). There is a decrease of the ONSD during positional changes from supine to upright position and pre- and postoperative EI correlated with preoperative variation ONSD_V1 (r = - 0.610 and - 0.648, p < 0.05). The mathematical function for preoperative EI estimation was EIpreop = 0.504 - 0.022 × ONSD_V1 + 0.101 × gender (M = 0; W = 1), (Durbin-Watson value = 1.94), and for postoperative was EIpostop = 0.487 - 0.022 × ONSD_V1 + 0.117 × gender; (Durbin-Watson value 2.23). CONCLUSIONS Ultrasonographic ONSD measurements in supine and upright position provide a potential method to quantify EI that can be conducted at the bedside.
Collapse
Affiliation(s)
- Mindaugas Urbonas
- Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Nijole Raskauskiene
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytenis Deltuva
- Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adomas Bunevicius
- Neuroscience Institute of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
48
|
Lochner P, Fousse M, Goi Junior JR, Mathur S, Merzou F. Rare cerebral vein thrombosis and COVID-19 vaccine: the role of orbit ultrasound. Neurol Sci 2022; 43:2957-2959. [PMID: 35083572 PMCID: PMC8791683 DOI: 10.1007/s10072-021-05839-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/17/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany.
| | - Mathias Fousse
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Joao Reinoldo Goi Junior
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Shrey Mathur
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Fatma Merzou
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| |
Collapse
|
49
|
Optic Nerve Sheath Diameter Ultrasound: A Non-Invasive Approach to Evaluate Increased Intracranial Pressure in Critically Ill Pediatric Patients. Diagnostics (Basel) 2022; 12:diagnostics12030767. [PMID: 35328319 PMCID: PMC8946972 DOI: 10.3390/diagnostics12030767] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 01/16/2023] Open
Abstract
Early diagnosis of increased intracranial pressure (ICP) is crucial for prompt diagnosis and treatment of intracranial hypertension in critically ill pediatric patients, preventing secondary brain damage and mortality. Although the placement of an external ventricular drain coupled to an external fluid-filled transducer remains the gold standard for continuous ICP monitoring, other non-invasive approaches are constantly being improved and can provide reliable estimates. The use of point-of-care ultrasound (POCUS) for the assessment of ICP has recently become widespread in pediatric emergency and critical care settings, representing a valuable extension of the physical examination. The aim of this manuscript is to review and discuss the basic principles of ultra-sound measurement of the optic nerve sheath diameter (ONSD) and summarize current evidence on its diagnostic value in pediatric patients with ICP. There is increasing evidence that POCUS measurement of the ONSD correlates with ICP, thus appearing as a useful extension of the physical examination in pediatrics, especially in emergency medicine and critical care settings for the initial non-invasive assessment of patients with suspected raised ICP. Its role could be of value even to assess the response to therapy and in the follow-up of patients with diagnosed intracranial hypertension if invasive ICP monitoring is not available. Further studies on more homogeneous and extensive study populations should be performed to establish ONSD reference ranges in the different pediatric ages and to define cut-off values in predicting elevated ICP compared to invasive ICP measurement.
Collapse
|
50
|
Sitanaya SN, Kamayanti F, Nugroho HA, Prabowo B. Comparing ultrasonographic optic nerve sheath diameter to head computed tomography scan to predict intracranial pressure elevation. SAGE Open Med 2022; 10:20503121221077834. [PMID: 35198210 PMCID: PMC8859652 DOI: 10.1177/20503121221077834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Intracranial hypertension is an emergency condition that needs to be recognized as soon as possible. Lumbar puncture, the gold standard diagnostic procedure for intracranial hypertension, is contraindicated in some conditions while brain imaging procedures may be too difficult to be performed on critically ill patients. To solve this problem, this study aims to assess an alternative method to detect intracranial hypertension by measuring optic nerve sheath diameter using ocular ultrasound and optic nerve sheath diameter difference in each etiology. Methods: This cross-sectional study was conducted at the Emergency Department of Dr Iskak Tulungagung General Hospital. Sixty-nine patients who visited the emergency room for the first onset of intracranial pathology were included for optic nerve sheath diameter measurement by ultrasound. Subjects were divided into elevated and non-elevated intracranial pressure groups based on head computed tomography scan findings. The optic nerve sheath diameter results were compared and analyzed. Result: There were 29 subjects in the elevated intracranial pressure group and 40 subjects in the non-elevated intracranial pressure group. The mean of optic nerve sheath diameter in the elevated and non-elevated intracranial pressure groups was 0.63 ± 0.06 and 0.57 ± 0.06 cm, respectively (p = 0.000). Based on receiver operating characteristics analysis, 0.58 cm was the most optimal cut-off value. Conclusion: Ultrasonographic optic nerve sheath diameter can be used to predict elevated intracranial pressure in suspected patients who are contraindicated to invasive intracranial pressure measurement or critically ill. There were significant differences between elevated and non-elevated intracranial pressure groups in stroke and trauma subjects.
Collapse
Affiliation(s)
| | - Fadhila Kamayanti
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
| | - Hari Adityo Nugroho
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
| | - Bobi Prabowo
- Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia
| |
Collapse
|