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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: 2.5] [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.
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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.
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2
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Azevedo MDR, de-Lima-Oliveira M, Belon AR, Brasil S, Teixeira MJ, Paiva WS, Bor-Seng-Shu E. Assessing ultrasonographic optic nerve sheath diameter in animal model with anesthesia regimens. Acta Cir Bras 2022; 37:e370308. [PMID: 35730866 PMCID: PMC9208240 DOI: 10.1590/acb370308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To determine the normal optical nerve sheath (ONS) diameter ultrasonography (ONSUS) and evaluate the possible effects of drugs on ONS diameter during anesthetic induction in healthy pigs. Methods: Healthy piglets were divided into three groups: a control group, that received xylazine and ketamine (X/K); other that received xylazine, ketamine and propofol (X/K/P); and a third group that received xylazine, ketamine, and thiopental (X/K/T). The sheath diameter was assessed by ultrasonography calculating the average of three measurements of each eye from the left and right sides. Results: 118 animals were anesthetized (49 X/K 33 X/K/P and 39 X/K/T). Mean ONS sizes on both sides in each group were 0.394 ± 0.048 (X/K), 0.407 ± 0.029 (X/K/P) and 0.378 ± 0.042 cm (X/K/T) (medians of 0.400, 0.405 and 0.389, respectively). The ONS diameter varied from 0.287–0.512 cm (mean of 0.302 ± 0.039 cm). For group X/K, the mean diameter was 0.394 ± 0.048 cm. Significant differences in ONS sizes between the groups P and T (X/K/P > X/K/T, p = 0.003) were found. No statistically significant differences were detected when other groups were compared (X/K = X/K/P, p = 0.302; X/K = X/K/T, p = 0.294). Conclusions: Sedation with thiopental lead to significative ONS diameter reduction in comparison with propofol. ONSUS may be useful to evaluate responses to thiopental administration.
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Affiliation(s)
- Maira de Robertis Azevedo
- MSc. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
| | - Marcelo de-Lima-Oliveira
- MD. PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
| | - Alessandro Rodrigo Belon
- PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Laboratory for Experimental Surgery - SãoPaulo (SP), Brazil
| | - Sérgio Brasil
- MD. PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
| | - Manoel Jacobsen Teixeira
- MD. PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
| | - Wellingson Silva Paiva
- MD. PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
| | - Edson Bor-Seng-Shu
- MD. PhD. Universidade de São Paulo - School of Medicine - Hospital das Clínicas - Division of Neurological Surgery - São Paulo (SP), Brazil
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Vitiello L, De Bernardo M, Capasso L, Cornetta P, Rosa N. Optic Nerve Ultrasound Evaluation in Animals and Normal Subjects. Front Med (Lausanne) 2022; 8:797018. [PMID: 35071277 PMCID: PMC8766506 DOI: 10.3389/fmed.2021.797018] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, ultrasonographic measurement of the optic nerve sheath diameter (ONSD) has been widely used to identify the presence of increased intracranial pressure (ICP). Intracranial hypertension is a life-threatening condition that can be caused by various neurological and non-neurological disorders, and it is associated to poor clinical results. Ultrasonography could be used to qualitatively and efficiently detect ICP increases, but to reach this purpose, clear cut-off values are mandatory. The aim of this review is to provide a wide overview of the most important scientific publications on optic nerve ultrasound normal values assessment published in the last 30 years. A total of 42 articles selected from PubMed medical database was included in this review. Our analysis showed that ocular ultrasonography is considered to be a valuable diagnostic tool, especially when intracranial hypertension is suspected, but unfortunately this research provided conflicting results that could be due to the different ultrasound protocols. This is mainly caused by the use of B scan alone, which presents several limitations. The use of B-scan coupled with the standardized A-scan approach could give more accurate, and reliable ultrasound evaluation, assuring higher data objectivity.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, Azienda Sanitaria Locale (ASL) Napoli 1, Naples, Italy
| | - Palmiro Cornetta
- Eye Unit, "Maria SS Addolorata" Hospital, Azienda Sanitaria Locale (ASL) Salerno, Eboli, Italy
| | - Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Butts C, Wilson J, Lasseigne L, Oral E, Kaban N. Ultrasound of the Optic Nerve Does Not Appear to Be a Consistently Reliable or Generalizable Method to Monitor Changes in Intracranial Pressure. J Intensive Care Med 2021; 37:663-670. [PMID: 34075826 DOI: 10.1177/08850666211021737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Invasive intracranial pressure (ICP) monitoring is the gold standard, but is not always readily accessible or practical. Ultrasound of the optic nerve sheath diameter (ONSD) has been proposed for detecting both elevation and change in the ICP. Our study is a prospective observational trial that seeks to determine if ultrasound can be reliably used to identify changes in ICP with naturally occurring variations in patient care. METHODS A convenience sample of patients with invasive ICP monitoring were enrolled. Patients were identified prior to interventions that were suspected to cause a change in ICP. Measurement of ICP and ONSD was obtained prior to the intervention, with repeated measurements of both variables obtained immediately following the intervention. RESULTS 36 total patients were enrolled. There was a positive correlation between the ICP and the right ONSD (r = 0.255, P = 0.0003) and the ICP and the left ONSD (r = 0.274, P < 0.0001). There was no statistically significant relationship between the change in either the ICP and the right ONSD (r -0.2 P = 0.282) or left ONSD (r 0.05 P = 0.805). The location of the lesion in the brain appears to significantly affect discordance between the ONSD and the ICP. CONCLUSIONS Ultrasound of the ONSD has shown promise as both a marker of elevated ICP and as a method to identify changes in pressure. Although the size of the ONSD and the measurement of ICP were correlated in our study, the ability to follow changes in ICP was not statistically significant. This indicates that use of ultrasound to track changes in ICP cannot be generalized and may be limited to specific circumstances. The location of the intracranial pathology appears to be a significant factor in discordance between the ICP and ONS diameter.
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Affiliation(s)
- Christine Butts
- Louisiana State University Health Sciences Section of Emergency Medicine, New Orleans, LA, USA
| | - Jason Wilson
- Louisiana State University Health Sciences Department of Neurosurgery, New Orleans, LA, USA
| | - Lindsay Lasseigne
- Louisiana State University Health Sciences Department of Neurosurgery, New Orleans, LA, USA
| | - Evrim Oral
- Louisiana State University Health Sciences Department of Biostatistics, New Orleans, LA, USA
| | - Nicole Kaban
- Louisiana State University Health Sciences Section of Emergency Medicine, New Orleans, LA, USA
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Mija R, Zubak I, Schuetz A, Glas M, Fung C, Jakob SM, Beck J, Z’Graggen WJ, Bloch A. Correlation of optic nerve and optic nerve sheath diameter with intracranial pressure in pigs. PLoS One 2020; 15:e0228242. [PMID: 32017786 PMCID: PMC6999916 DOI: 10.1371/journal.pone.0228242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/11/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Several studies have shown an association between intracranial pressure and the diameter of the optic nerve sheath measured by transbulbar ultrasonography. To understand the pathophysiology of this phenomenon, we aimed to measure the changes of the optic nerve, optic nerve sheath and perineural space separately with increasing intracranial pressure in a porcine model. Methods An external ventricular drain was placed into the third ventricle through a right paramedian burrhole in eight anesthesized pigs. The diameters of the optic nerve and the optic nerve sheath were measured while the intracranial pressure (ICP) was increased in steps of 10mmHg from baseline up to 60 mmHg. Results The median diameters of the optic nerve (ON) increased from 0.36 cm (baseline– 95% confidence interval (CI) 0.33 cm to 0.45 cm) to 0.68 cm (95% CI 0.57 cm to 0.82 cm) at ICP of 60 mmHg (p<0.0001) and optic nerve sheath (ONS) from 0.88 cm (95% CI 0.79 cm to 0.98 cm) to 1.24 cm (95% CI 1.02 cm to 1.38 cm) (p< 0.002) while the median diameter of the perineural space (PNS) (baseline diameter 95% CI 0.40 cm to 0.59 cm to diameters at ICP 60 95% CI 0.38 cm to 0.62 cm) did not change significantly (p = 0.399). Multiple comparisons allowed differentiation between baseline and values ≥40 mmHg for ON (p = 0.017) and between baseline and values ≥ 50mmHg for ONS (p = 0.006). A linear correlation between ON (R2 = 0.513, p<0.0001) and ONS (R2 = 0.364, p<0.0001) with ICP was found. The median coefficient of variation for intra- and inter-investigator variability was 8% respectively 2.3%. Conclusion Unexpectedly, the increase in ONS diameter with increasing ICP is exclusively related to the increase of the diameter of the ON. Further studies should explore the reasons for this behaviour.
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Affiliation(s)
- R. Mija
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - I. Zubak
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A. Schuetz
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M. Glas
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C. Fung
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S. M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J. Beck
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - W. J. Z’Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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Point-of-care resuscitation research: From extreme to mainstream: Trauma Association of Canada Fraser Gurd Lecture 2019. J Trauma Acute Care Surg 2020; 87:571-581. [PMID: 31136525 DOI: 10.1097/ta.0000000000002375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Gurd Family surgical legacy was deeply intertwined with National service in both World Wars. My own personal research mission has attempted to emulate such service, by enhancing the tools and techniques available to facilitate point-of-care diagnosis and resuscitation in extreme and adverse environments. Our efforts involving point-of-care diagnosis/resuscitation and the telementored guidance of those remotely responding to catastrophic injury have included collaborations with National Aeronautics and Space Administration (NASA) the Canadian Space Agency, the Canadian Forces, its democratic allies, and non-governmental surgical organizations. Research has been conducted in resuscitative suites and operating theaters, research laboratories, parabolic flight aircraft, on humanitarian surgical missions, and from ski-hills and firehalls. The initial phases of these efforts involved inaugural studies in resuscitative sonography including defining the Extended Focused Assessment with Sonography for Trauma (EFAST) examination. Although the original work was commissioned for Space Medicine, generalization to mainstream practice further justifies space medicine research. Iterative steps in advancing telementored resuscitation have subsequently involved the maturation of space-mandated telementored ultrasound support (TMUS), exploration of TMUS in terrestrial clinical practice, and the creation of increasingly mobile (hand-held) TMUS solutions. Subsequently it was recognized that teleultrasound is simply one informatic dimension of remote telemedicine, and current efforts are focused in a Program known as TeleMentored Ultrasound Supported Medical Interactions (TMUSMI) of remote responders required to intervene with catastrophic trauma. While this research program has yielded many techniques and findings that have benefited mainstream terrestrial practice, these investigations are currently ongoing, and we hope to demonstrate that TMUSMI may benefit all Canadians especially those in remote areas, as well as potentially every global inhabitant without immediate access to care. Further, we propose that to fully utilize these techniques, a new specialty, that of the remote medical mentor will be required, a new specialty that will require the creation and scientific validation of its principles and techniques.
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East L, Lyon M, Agrawal P, Islam Z, Newell M, Hockman T, Heger IM, Xu H, Kuchinski AM, Gibson RW. Increased Intracranial Pressure Damages Optic Nerve Structural Support. J Neurotrauma 2019; 36:3132-3137. [PMID: 31256706 DOI: 10.1089/neu.2019.6490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Optic nerve sheath diameter (ONSD) is used clinically as a noninvasive measure for elevated intracranial pressure (ICP). This study had two purposes: to investigate the immediate effects optic nerve sheath (ONS) dilation post-ICP increase on trabecular fibers connecting the optic nerve to the ONS and to document any changes in these fibers 30 days post-increased ICP. In a swine model, ICP was increased by inflating a Foley catheter balloon in the epidural space. Three control pigs received the catheter insertion without inflation (no increase in ICP) and four experimental pigs received the catheter with inflation (increased ICP). The control and two randomly selected pigs with increased ICP were euthanized immediately after the procedure. The two other pigs were euthanized 30 days post-catheter inflation. For all pigs, the ONS was removed and imaged using a scanning electron microscope, calculating percent porosity values. Porosity values for the experimental groups (Immediately measured [IM] μ = 0.5749; Delayed measured [DM] μ = 0.5714) were larger than the control group (μ = 0.4336) and statistically significant (IM vs. Control, p = 0.0018; DM vs. Control, p = 0.0092). There was no significant difference (p = 0.9485) in porosity of the DM group when compared with the IM group. This study demonstrated that the trabecular fibers immediately post-increased ICP (ONS dilation) were more porous than the control and remained statistically different (more porous) after 30 days. These results suggest a structural change that occurs in the ONS with elevations in ICP.
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Affiliation(s)
- Lauren East
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Matthew Lyon
- Department of Emergency Medicine, Augusta University, Augusta, Georgia.,Center for Ultrasound Education, Augusta University, Augusta, Georgia
| | - Parth Agrawal
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Zulqar Islam
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Maegan Newell
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Tyler Hockman
- Division of Laboratory Animal Services, Augusta University, Augusta, Georgia
| | - Ian M Heger
- Department of Neurosurgery, Augusta University, Augusta, Georgia
| | - Hongyan Xu
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | | | - Robert W Gibson
- Department of Emergency Medicine, Augusta University, Augusta, Georgia
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Colombo R, Agarossi A, Borghi B, Ottolina D, Bergomi P, Ballone E, Minari C, Della Porta V, Menozzi E, Figini S, Fossali T, Catena E. The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter. J Clin Monit Comput 2019; 34:1295-1302. [PMID: 31691148 DOI: 10.1007/s10877-019-00418-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
Both the steep head-down position and pneumoperitoneum increase the intracranial pressure (ICP), and their combination for a prolonged period during laparoscopic radical prostatectomy (LRP) might influence the central nervous system homeostasis. Changes in optic nerve sheath diameter (ONSD) may reflect those in ICP. This study aims to quantify the change in ONSD in response to peritoneal CO2 insufflation and steep Trendelenburg position during LRP. ONSD was measured by ultrasound in 20 patients undergoing LRP and ten awake healthy volunteers. In patients, ONSD was assessed at baseline immediately after induction of general anesthesia in supine position, 10 and 60 min from baseline in a 25° head-down position during pneumoperitoneum, and after deflation of pneumoperitoneum with the patient supine at 0° angle. ONSD in controls was assessed at baseline with the patient lying supine, after 10 and 60 min of 25° head-down position, and 10 min after repositioning at 0° angle. ONSD increased significantly in both patients and controls (p < 0.0001) without between-group differences. The mean increase was 10.3% (95% CI 7.7-12.9%) in patients versus 7.5% (95% CI 2.5-12.6%) in controls (p = 0.28), and didn't affect the time to recovery from anesthesia. In the studied patients, with a limited increase of end-tidal CO2 and airway pressure, and low volume fluid infusion, the maximal ONSD was always below the cut-off value suspect for increased ICP. ONSD reflects the changes in hydrostatic pressure in response to steep Trendelenburg position, and its increase might be minimized by careful handling of general anesthesia.
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Affiliation(s)
- Riccardo Colombo
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Andrea Agarossi
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Beatrice Borghi
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Davide Ottolina
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Paola Bergomi
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Elisabetta Ballone
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Caterina Minari
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Vanessa Della Porta
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Emanuela Menozzi
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Stefano Figini
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Emanuele Catena
- Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario - University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy
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Arthur J, Duran-Gehring P, Kumetz C, Chadwick S, McIntosh M. Cerebral Venous Thrombosis: An Uncommon Cause of Papilledema on Bedside Ocular Ultrasound. J Emerg Med 2019; 56:288-293. [PMID: 30538085 DOI: 10.1016/j.jemermed.2018.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension. CASE REPORT A 25-year-old woman presented with a complaint of bifrontal throbbing headache and blurry vision. A bedside ultrasound of the orbit suggested increased intracranial pressure. A subsequent computed tomography venogram demonstrated a left transverse sinus thrombosis. The patient was started on enoxaparin and admitted for bridging to warfarin and evaluation for hypercoagulable state. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: CVT is a rare form of stroke that carries a high rate of mortality and morbidity and masquerades as more common and benign diagnoses. Emergency department bedside ultrasound of the orbit may make the diagnosis of CVT more attainable by identifying patients with increased intracranial pressure.
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Affiliation(s)
- Jason Arthur
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Petra Duran-Gehring
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Christopher Kumetz
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Steven Chadwick
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Mark McIntosh
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
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10
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Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Eur J Emerg Med 2019; 25:e24-e28. [PMID: 28727580 DOI: 10.1097/mej.0000000000000490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Rigid cervical collars are known to increase intracranial pressure (ICP) in severe traumatic brain injury (TBI). Cerebral blood flow might decrease according to the Kellie Monroe doctrine. For this reason, the use of the collar in patients with severe TBI has been abandoned from several trauma protocols in the Netherlands. There is no evidence on the effect of a rigid collar on ICP in patients with mild or moderate TBI or indeed patients with no TBI. As a first step we tested the effect in healthy volunteers with normal ICPs and intact autoregulation of the brain. METHODS In this prospective blinded cross-over study, we evaluated the effect of application of a rigid cervical collar in 45 healthy volunteers by measuring their optical nerve sheath diameter (ONSD) by transocular sonography. Sonographic measurement of the ONSD behind the eye is an indirect noninvasive method to estimate ICP and pressure changes. RESULTS We included 22 male and 23 female volunteers. In total 360 ONSD measurements were performed in these 45 volunteers. Application of a collar resulted in a significant increase in ONSD in both the left (β=0.06, 95% confidence interval: 0.05-0.07, P<0.001) and the right eye (β=0.01, 95% confidence interval: 0.00-0.02, P=0.027) CONCLUSION: Application of a rigid cervical collar significantly increases the ONSD in healthy volunteers with intact cerebral autoregulation. This suggests that ICP may increase after application of a collar. In healthy volunteers, this seems to be of minor importance. On the basis of our findings the effect of a collar on ONSD and ICP in patients with mild and moderate TBI needs to be determined.
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11
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Cardim D, Griesdale DE, Ainslie PN, Robba C, Calviello L, Czosnyka M, Smielewski P, Sekhon MS. A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest. Resuscitation 2019; 137:221-228. [PMID: 30629992 DOI: 10.1016/j.resuscitation.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
AIM Increased intracranial pressure (ICP) in hypoxic ischaemic brain injury (HIBI) can cause secondary ischaemic brain injury and culminate in brain death. Invasive ICP monitoring is limited by associated risks in HIBI patients. We sought to evaluate the agreement between invasive ICP measurements and non-invasive estimators of ICP (nICP) in HIBI patients. METHODS Eligible consecutive adult (age>18) cardiac arrest patients with HIBI were included as part of a single centre prospective interventional study. Invasive ICP monitoring and nICP measurements were undertaken using: a) transcranial Doppler ultrasonography (TCD), b) optic nerve sheet diameter ultrasound (ONSD) and c) jugular venous bulb pressure (JVP). Multiple measurements applied in linear mixed-effects models were considered to obtain the correlation coefficient between ICP and nICP as well as their predictive abilities to detect intracranial hypertension (ICP≥20mm Hg). RESULTS Eleven patients were included (median age of 47 [range 20-71], 8 males and 3 females). There was a linear relationship between ICP and nICP with ONSD (R=0.53 [p<0.0001]), JVP (R=0.38 [p<0.001]) and TCD (R=0.30 [p<0.01]). The ability to predict intracranial hypertension was highest for ONSD and TCD (area under the receiver operating curve (AUC)=0.96 [95% CI: 0.90-1.00] and AUC=0.91 [95% CI: 0.83-1.00], respectively). JVP presented the weakest prediction ability (AUC=0.75 [95% CI: 0.56-0.94]). CONCLUSIONS ONSD and TCD methods demonstrated agreement with invasively-monitored ICP, suggesting their potential roles in the detection of intracranial hypertension in HIBI after cardiac arrest.
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Affiliation(s)
- Danilo Cardim
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,.
| | - Donald E Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,; Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Philip N Ainslie
- Department of Health and Exercise Sciences, The University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Chiara Robba
- Anaesthesia and Intensive Care, IRCCS San Martino, Genova, Italy
| | - Leanne Calviello
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom; Institute of Electronic Systems, Warsaw University of Technology, Poland
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada
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12
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Fichtner J, Ulrich CT, Fung C, Cipriani D, Gralla J, Piechowiak EI, Schlachetzki F, Z'Graggen WJ, Raabe A, Beck J. Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension - a consecutive cohort study. Cephalalgia 2018; 39:306-315. [PMID: 30099952 DOI: 10.1177/0333102418793640] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. METHODS We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. RESULTS Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (-0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. CONCLUSIONS The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.
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Affiliation(s)
- Jens Fichtner
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Christian T Ulrich
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Fung
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Debora Cipriani
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- 2 Institute of Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Eike Immo Piechowiak
- 2 Institute of Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Felix Schlachetzki
- 3 Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Werner J Z'Graggen
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland.,4 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jürgen Beck
- 1 Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
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13
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Sujata N, Tobin R, Tamhankar A, Gautam G, Yatoo AH. A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anesthesia in robot-assisted laparoscopic pelvic surgery. J Robot Surg 2018; 13:267-273. [PMID: 30006862 DOI: 10.1007/s11701-018-0849-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
Robot-assisted surgery can cause raised intracranial pressures (ICP) due to steep trendelenburg position and pneumoperitoneum. The choice of anesthetic agents can influence the ICP, which can be measured indirectly by correlating it with the sonographically measured optic nerve sheath diameter (ONSD). In this study, our primary aim was to compare the change from baseline of the ONSD during propofol versus sevoflurane-maintained anesthesia in patients undergoing robotic pelvic surgery. In this prospective, interventional, double-blinded study, we randomised 50 patients into two groups P and S. Subjects in group P received intravenous propofol infusion while those in group S received inhalation sevoflurane for maintenance of anesthesia. The ONSD at fixed intervals was noted as the mean of four values measured using ultrasound in both eyes by two independent anesthesiologists who were blinded to the group allocation. The patient demographics and baseline parameters were similar. The mean maximum rise in ONSD from baseline was 0.01 ± 0.01 cm in group P while it was 0.03 ± 0.01 cm in group S (p = 0.001). Percentage change from baseline in group P was 3.41 ± 1.81% and 8.00 ± 2.95% in group S (p = 0.001). We found a positive correlation between the duration of surgery and the maximum rise in ONSD in group S (p = 0.003), but not in group P. Propofol-based total intravenous anesthesia is more effective than inhalation sevoflurane in attenuating the increase in ICP as correlated with the ONSD during robotic pelvic surgery.Clinical trial registration: Yes; Principal investigator: Nambiath Sujata; Trial number: REF/2016/11/012713 (registered); Trial registry: CTRI- http://ctri.nic.in .
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Affiliation(s)
- Nambiath Sujata
- Department of Anesthesia and Pain Management, Max Hospital, No. 1 Press Enclave Road, Saket, New Delhi, 110017, India.
| | - Raj Tobin
- Department of Anesthesia and Pain Management, Max Hospital, No. 1 Press Enclave Road, Saket, New Delhi, 110017, India
| | | | - Gagan Gautam
- Department of Uro-Oncology, Max Hospital, New Delhi, India
| | - Abdul Hamid Yatoo
- Department of Anesthesia and Pain Management, Max Hospital, No. 1 Press Enclave Road, Saket, New Delhi, 110017, India
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How Ultrasonographic Measurement of Optic Nerve Sheath Diameter (ONSD) Aids in Diagnosis of Cerebrovascular Accident in a Patient on Ventilator? J Neurosurg Anesthesiol 2018; 29:364-365. [PMID: 26998649 DOI: 10.1097/ana.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Lyon M, Agrawal P, Friez K, Gordon R, Morales I, Fang Zhang L, Xu H, Heger I, Gibson RW. Effect of History of Mild Traumatic Brain Injury on Optic Nerve Sheath Diameter Changes after Valsalva Maneuver. J Neurotrauma 2018; 35:695-702. [PMID: 29356623 DOI: 10.1089/neu.2017.5164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Optic nerve sheath diameter (ONSD) measured by transocular ultrasound is a marker of real-time intracranial pressure (ICP). The objective of this study was to evaluate the association between optic nerve sheath (ONS) dilation after a Valsalva maneuver and a prior history of mild to moderate traumatic brain injury (mTBI) in a heterogeneous sample of participants. Participants were excluded if they had had a recent brain injury, were symptomatic from a prior brain injury, had a history consistent with severe TBI and/or had undergone intracranial surgery. Ninety-five participants with and without a history of mTBI were included in the study. Transocular ultrasound of the ONS was performed before and after a Valsalva maneuver. Differences in the ONSD before and after a Valsalva maneuver were analyzed and correlated to the participants' history of mTBI. Baseline ONSD measurements between groups were not statistically significant. Following Valsalva, participants with a history of mTBI had a statistically significant increase in the ONSD compared with participants with no history of mTBI. This significant difference persisted after controlling for age, race, and sex. This study demonstrated an association between a prior history of mTBI and dilation of the ONS after Valsalva maneuver in a sample of asymptomatic participants, which was not seen in participants without a history of mTBI.
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Affiliation(s)
- Matthew Lyon
- 1 Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia, Augusta University , Augusta, Georgia .,2 Center for Ultrasound Education, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Parth Agrawal
- 3 Medical Scholars Program, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Kyle Friez
- 3 Medical Scholars Program, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Richard Gordon
- 1 Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia, Augusta University , Augusta, Georgia .,2 Center for Ultrasound Education, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Ivan Morales
- 3 Medical Scholars Program, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Li Fang Zhang
- 4 Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Hongyan Xu
- 4 Department of Biostatistics and Epidemiology, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Ian Heger
- 5 Department of Neurosurgery, Medical College of Georgia, Augusta University , Augusta, Georgia
| | - Robert W Gibson
- 1 Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia, Augusta University , Augusta, Georgia
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Effect of Pneumoperitoneum and Patient Positioning on Intracranial Pressures during Laparoscopy: A Prospective Comparative Study. J Minim Invasive Gynecol 2018; 25:147-152. [DOI: 10.1016/j.jmig.2017.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/23/2022]
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17
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Noninvasive Brain Physiology Monitoring for Extreme Environments: A Critical Review. J Neurosurg Anesthesiol 2016; 27:318-28. [PMID: 25811362 DOI: 10.1097/ana.0000000000000175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our ability to monitor the brain physiology is advancing; however, most of the technology is bulky, expensive, and designed for traditional clinical settings. With long-duration space exploration, there is a need for developing medical technologies that are reliable, low energy, portable, and semiautonomous. Our aim was to review the state of the art for noninvasive technologies capable of monitoring brain physiology in diverse settings. A literature review of PubMed and the Texas Medical Center library sites was performed using prespecified search criteria to identify portable technologies for monitoring physiological aspects of the brain physiology. Most brain-monitoring technologies require a moderate to high degree of operator skill. Some are low energy, but many require a constant external power supply. Most of the technologies lack the accuracy seen in gold standard measures, due to the need for calibration, but may be useful for screening or monitoring relative changes in a parameter. Most of the technologies use ultrasound or electromagnetic radiation as energy sources. There is an important need for further development of portable technologies that can be operated in a variety of extreme environments to monitor brain health.
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18
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Fichtner J, Ulrich CT, Fung C, Knüppel C, Veitweber M, Jilch A, Schucht P, Ertl M, Schömig B, Gralla J, Z'Graggen WJ, Bernasconi C, Mattle HP, Schlachetzki F, Raabe A, Beck J. Management of spontaneous intracranial hypotension - Transorbital ultrasound as discriminator. J Neurol Neurosurg Psychiatry 2016; 87:650-5. [PMID: 26285586 PMCID: PMC4893146 DOI: 10.1136/jnnp-2015-310853] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Spontaneous intracranial hypotension (SIH) is most commonly caused by cerebrospinal fluid (CSF) leakage. Therefore, we hypothesised that patients with orthostatic headache (OH) would show decreased optic nerve sheath diameter (ONSD) during changes from supine to upright position. METHODS Transorbital B-mode ultrasound was performed employing a high-frequency transducer for ONSD measurements in the supine and upright positions. Absolute values and changes of ONSD from supine to upright were assessed. Ultrasound was performed in 39 SIH patients, 18 with OH and 21 without OH, and in 39 age-matched control subjects. The control group comprised 20 patients admitted for back surgery without headache or any orthostatic symptoms, and 19 healthy controls. RESULTS In supine position, mean ONSD (±SD) was similar in patients with (5.38±0.91 mm) or without OH (5.48±0.89 mm; p=0.921). However, in upright position, mean ONSD was different between patients with (4.84±0.99 mm) and without OH (5.53±0.99 mm; p=0.044). Furthermore, the change in ONSD from supine to upright position was significantly greater in SIH patients with OH (-0.53±0.34 mm) than in SIH patients without OH (0.05±0.41 mm; p≤0.001) or in control subjects (0.01±0.38 mm; p≤0.001; area under the curve: 0.874 in receiver operating characteristics analysis). CONCLUSIONS Symptomatic patients with SIH showed a significant decrease of ONSD, as assessed by ultrasound, when changing from the supine to the upright position. Ultrasound assessment of the ONSD in two positions may be a novel, non-invasive tool for the diagnosis and follow-up of SIH and for elucidating the pathophysiology of SIH.
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Affiliation(s)
- Jens Fichtner
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Christian T Ulrich
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Christin Knüppel
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Martina Veitweber
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Astrid Jilch
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Michael Ertl
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Beate Schömig
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Jan Gralla
- Institute of Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Clinical Trial Unit, Neurocenter Bern, University of Bern, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Felix Schlachetzki
- Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
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19
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Ilie LA, Thomovsky EJ, Johnson PA, Bentley RT, Heng HG, Lee HC, Moore GE. Relationship between intracranial pressure as measured by an epidural intracranial pressure monitoring system and optic nerve sheath diameter in healthy dogs. Am J Vet Res 2016. [PMID: 26207971 DOI: 10.2460/ajvr.76.8.724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association between ultrasonographically measured optic nerve sheath diameter (ONSD) and acute increases in intracranial pressure (ICP) as measured by an epidural intracranial pressure monitoring system (EICPMS) in healthy dogs. ANIMALS 6 young healthy dogs. PROCEDURES An EICPMS connected to a pressure monitor was used to generate a continuous pressure waveform in each anesthetized dog. A 22-gauge IV catheter was inserted into the brain parenchyma through the contralateral parietal bone, and 0.5 to 2.0 mL of anticoagulated autologous blood was injected at predetermined intervals. At baseline (immediately after EICPMS placement) and following each injection, the ICP as indicated by EICPMS was recorded, and 3 ultrasonographic images of the optic nerve sheath of each eye were obtained. The ONSD was measured at maximum diameter and at 5 mm caudal to the optic disk. RESULTS In linear models, the maximum ONSD was positively associated with increasing ICP. Specifically, the rate of maximum ONSD increase was greater for pressures ≤ 20 mm Hg above baseline (0.0534 mm/1 mm Hg ICP increase) than for pressures > 40 mm Hg above baseline (0.0087 mm/1 mm Hg ICP increase). The relationship of ICP to maximum ONSD was slightly nonlinear and best explained by comparison of fractional polynomial regression models. CONCLUSIONS AND CLINICAL RELEVANCE ICP was positively and nonlinearly associated with increasing maximum ONSD, especially when ICP was ≤ 20 mm Hg above baseline, supporting the conclusion that ultrasonographic measurement of maximum ONSD may provide a noninvasive monitoring tool for evaluation of ICP in dogs. Further research is needed to assess the utility of these measurements in clinical patients.
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Vespa P, Menon D, Le Roux P. The International Multi-disciplinary Consensus Conference on Multimodality Monitoring: future directions and emerging technologies. Neurocrit Care 2015; 21 Suppl 2:S270-81. [PMID: 25208681 DOI: 10.1007/s12028-014-0049-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuromonitoring has evolved rapidly in recent years and there now are many new monitors that have revealed a great deal about the ongoing pathophysiology of brain injury and coma. Further evolution will include the consolidation of multi-modality monitoring (MMM), the development of next-generation informatics tools to identify complex physiologic events and decision support tools to permit targeted individualized care. In this review, we examine future directions and emerging technologies in neuromonitoring including: (1) device development, (2) what is the current limitation(s) of MMM in its present format(s), (3) what would improve the ability of MMM to enhance neurocritical care, and (4) how do we develop evidence for use of MMM?
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Affiliation(s)
- Paul Vespa
- Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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21
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Tawfik EA, Walker FO, Cartwright MS. Neuromuscular ultrasound of cranial nerves. J Clin Neurol 2015; 11:109-21. [PMID: 25851889 PMCID: PMC4387476 DOI: 10.3988/jcn.2015.11.2.109] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 02/06/2023] Open
Abstract
Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.
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Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Francis O Walker
- Department of Neurology, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Wang L, Feng L, Yao Y, Wang Y, Chen Y, Feng J, Xing Y. Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population. PLoS One 2015; 10:e0117939. [PMID: 25664663 PMCID: PMC4322040 DOI: 10.1371/journal.pone.0117939] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022] Open
Abstract
Ultrasonography of the optic nerve sheath diameter (ONSD) is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure (ICP). The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture (LP) in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001). However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.
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Affiliation(s)
- Lijuan Wang
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Liangshu Feng
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yuzhi Wang
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ying Chen
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Jiachun Feng
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
- * E-mail: (JF); (YX)
| | - Yingqi Xing
- The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
- * E-mail: (JF); (YX)
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Sanzari JK, Muehlmatt A, Savage A, Lin L, Kennedy AR. Increased intracranial pressure in mini-pigs exposed to simulated solar particle event radiation. ACTA ASTRONAUTICA 2014; 94:807-812. [PMID: 25242832 PMCID: PMC4166565 DOI: 10.1016/j.actaastro.2013.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Changes in intracranial pressure (ICP) during space flight have stimulated an area of research in space medicine. It is widely speculated that elevations in ICP contribute to structural and functional ocular changes, including deterioration in vision, which is also observed during space flight. The aim of this study was to investigate changes in OP occurring as a result of ionizing radiation exposure (at doses and dose-rates relevant to solar particle event radiation). We used a large animal model, the Yucatan mini-pig, and were able to obtain measurements over a 90 day period. This is the first investigation to show long term recordings of ICP in a large animal model without an invasive craniotomy procedure. Further, this is the first investigation reporting increased ICP after radiation exposure.
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Affiliation(s)
| | | | | | | | - AR Kennedy
- Corresponding author: Ann R. Kennedy, D. Sc., 3620 Hamilton Walk, 183 John Morgan Building, Philadelphia, PA, 19104, USA, , (w) +1 215-898-0079, (f) +1 215-898-1141
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Scrivani PV, Fletcher DJ, Cooley SD, Rosenblatt AJ, Erb HN. T2-WEIGHTED MAGNETIC RESONANCE IMAGING MEASUREMENTS OF OPTIC NERVE SHEATH DIAMETER IN DOGS WITH AND WITHOUT PRESUMED INTRACRANIAL HYPERTENSION. Vet Radiol Ultrasound 2013; 54:263-70. [DOI: 10.1111/vru.12023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Peter V. Scrivani
- From the Department of Clinical Sciences; Department of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine, Cornell University; Ithaca; NY; 14853
| | - Daniel J. Fletcher
- From the Department of Clinical Sciences; Department of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine, Cornell University; Ithaca; NY; 14853
| | - Stacy D. Cooley
- From the Department of Clinical Sciences; Department of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine, Cornell University; Ithaca; NY; 14853
| | - Alana J. Rosenblatt
- From the Department of Clinical Sciences; Department of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine, Cornell University; Ithaca; NY; 14853
| | - Hollis N. Erb
- From the Department of Clinical Sciences; Department of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine, Cornell University; Ithaca; NY; 14853
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Teismann NA, Lenaghan P, Stein J, Green A. Will the real optic nerve sheath please stand up? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:130-131. [PMID: 22215781 DOI: 10.7863/jum.2012.31.1.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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