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Kishore KV, Patwardhan A, Aravinda HR, Mustare V, Ramakrishnan S. Characterization of Ocular Sonography Findings and their Relationship to Clinical Features from a South Indian Cohort of Idiopathic Intracranial Hypertension. Ann Indian Acad Neurol 2024; 27:146-151. [PMID: 38751906 PMCID: PMC11093174 DOI: 10.4103/aian.aian_1057_23] [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: 12/03/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) typically manifests with headache, accompanied by papilledema and visual loss, and has a higher prevalence in females. In recent years, ocular sonography, particularly, measurement of optic nerve sheath diameter (ONSD), is being investigated for diagnosis of IIH. Methods A total of 35 patients over the age of 18 years, fulfilling the modified Dandy's criteria for diagnosis of IIH were included. Patients underwent assessment with magnetic resonance imaging, lumbar puncture, and ocular sonography to measure ONSD and ocular arterial indices. Results The mean ONSD values (in centimeters) in the right eye of patients with IIH was 0.57 ± 0.13, while it was 0.48 ± 0.03 in controls. In the left eye, the mean ONSD value (cm) was 0.59 ± 0.13 in patients with IIH and 0.48 ± 0.03 in controls. ONSD was significantly higher in cases compared to controls (P < 0.001, Welch test). Pulsatility index of the central retinal artery was significantly higher in cases compared to controls (P < 0.001, Welch test). Resistance index of the ophthalmic artery was statistically significant (P < 0.005, Welch test). Receiver operating characteristic curve analysis revealed a cutoff value of 5.1 mm on the right side and 5 mm on the left side had a sensitivity and specificity of more than 80% for IIH diagnosis. Conclusion Our study provides insights into the utility of optic nerve sheath measurements and arterial indices in the diagnosis of IIH in a South Indian cohort. Further research is needed to fully understand the longitudinal relationship of these parameters and treatment outcomes in IIH.
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Affiliation(s)
- KV Kishore
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ameya Patwardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - HR Aravinda
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Bakola E, Palaiodimou L, Eleftheriou A, Foska K, Pikouli A, Stefanatou M, Chondrogianni M, Velonakis G, Andreadou E, Papadopoulou M, Karapanayiotides T, Krogias C, Arvaniti C, Tsivgoulis G. Transorbital sonography in idiopathic intracranial hypertension: Single-center study, systematic review and meta-analysis. J Neuroimaging 2024; 34:108-119. [PMID: 37822030 DOI: 10.1111/jon.13160] [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: 07/23/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Transorbital sonography (TOS) provides a noninvasive tool to detect intracranial pressure by assessing optic nerve sheath diameter (ONSD) and optic disc elevation (ODE). The utility of TOS in the diagnosis of idiopathic intracranial hypertension (IIH) has been increasingly recognized. METHODS A single-center case-control study sought to compare TOS-acquired ONSD and ODE among IIH-cases versus patients with other neurological diseases (controls). Furthermore, a systematic review and meta-analysis was conducted to present pooled mean differences and diagnostic measures of ONSD and ODE between IIH-cases and controls. RESULTS In the single-center study, consisting of 31 IIH-cases and 34 sex- and age-matched controls, ONSD values were higher among IIH-cases than controls (p<.001), while ODE was more prevalent in cases (65% vs. 15%; p<.001). The receiver-operating characteristic (ROC)-curve analysis revealed that the optimal cutoff value of ONSD for predicting IIH was 5.15 mm, with an area under the curve (AUC) of 0.914 (95% confidence interval [CI]: 0.861-0.967) and sensitivity and specificity values of 85% and 90%, respectively. In a meta-analysis of 14 included studies with 415 IIH-cases, ONSD and ODE values were higher in IIH-cases than controls (mean difference in ONSD 1.20 mm; 95% CI: 0.96-1.44 mm and in ODE 0.3 mm; 95% CI: 0.33-0.67 mm). With regard to ONSD, pooled sensitivity, specificity, and diagnostic odds ratio were calculated at 85.5% (95% CI: 77.9-90.8%), 90.7% (95% CI: 84.6-94.5%), and 57.394 (95% CI: 24.597-133.924), respectively. The AUC in summary ROC-curve analysis was 0.878 (95% CI: 0.858-0.899) with an optimal cutoff point of 5.0 mm. CONCLUSIONS TOS has a high diagnostic utility for the noninvasive diagnosis of IIH and may deserve wider implementation in everyday clinical practice.
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Affiliation(s)
- Eleni Bakola
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Eleftheriou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Foska
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Pikouli
- Third Department of Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Stefanatou
- First Department of Neurosurgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Elissavet Andreadou
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - Chrysa Arvaniti
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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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.
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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.
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Luca MD, Biondino D, Gioia M, Marca AL. Comment on "Measuring optic nerve sheath diameter using ultrasonography in patients with idiopathic intracranial hypertension". ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:610-612. [PMID: 37379873 DOI: 10.1055/s-0043-1768673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Martina De Luca
- University of Salerno, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi SA, Italy
| | - Danilo Biondino
- University of Salerno, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi SA, Italy
| | - Marco Gioia
- University of Salerno, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi SA, Italy
| | - Aniello La Marca
- University of Salerno, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi SA, Italy
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Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J Clin Med 2023; 12:jcm12062209. [PMID: 36983213 PMCID: PMC10051320 DOI: 10.3390/jcm12062209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: Intracranial pressure (ICP) monitoring plays a key role in the treatment of patients in intensive care units, as well as during long-term surgeries and interventions. The gold standard is invasive measurement and monitoring via ventricular drainage or a parenchymal probe. In recent decades, numerous methods for non-invasive measurement have been evaluated but none have become established in routine clinical practice. The aim of this study was to reflect on the current state of research and shed light on relevant techniques for future clinical application. (2) Methods: We performed a PubMed search for “non-invasive AND ICP AND (measurement OR monitoring)” and identified 306 results. On the basis of these search results, we conducted an in-depth source analysis to identify additional methods. Studies were analyzed for design, patient type (e.g., infants, adults, and shunt patients), statistical evaluation (correlation, accuracy, and reliability), number of included measurements, and statistical assessment of accuracy and reliability. (3) Results: MRI-ICP and two-depth Doppler showed the most potential (and were the most complex methods). Tympanic membrane temperature, diffuse correlation spectroscopy, natural resonance frequency, and retinal vein approaches were also promising. (4) Conclusions: To date, no convincing evidence supports the use of a particular method for non-invasive intracranial pressure measurement. However, many new approaches are under development.
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Affiliation(s)
- Sebastian Johannes Müller
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Correspondence: ; Tel.: +49-(0)711-278-34501
| | - Elina Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Matthew J. Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, MA 01655, USA
| | - Stephan Felber
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Stiftungsklinikum Mittelrhein, D-56068 Koblenz, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, D-47057 Duisburg, Germany
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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.
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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
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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
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