1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Kerscher SR, Zipfel J, Bevot A, Sollmann N, Haas-Lude K, Tellermann J, Schuhmann MU. Non-Invasive Quantitative Approximation of Intracranial Pressure in Pediatric Idiopathic Intracranial Hypertension Based on Point-of-Care Ultrasound of the Optic Nerve Sheath Diameter. Brain Sci 2023; 14:32. [PMID: 38248247 PMCID: PMC10812972 DOI: 10.3390/brainsci14010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND To investigate whether ultrasound-based optic nerve sheath diameter (US-ONSD) is a reliable measure to follow up children with idiopathic intracranial hypertension (IIH). In addition, to analyze the inter- and intra-individual relationships between US-ONSD and intracranial pressure (ICP), and to investigate whether an individualized mathematical regression equation obtained from two paired US-ONSD/ICP values can be used to approximate ICP from US-ONSD values. METHODS 159 US examinations and 53 invasive ICP measures via lumbar puncture (LP) were performed in 28 children with IIH. US-ONSD was measured using a 12 Mhz linear transducer and compared to ICP values. In 15 children, a minimum of 2 paired US-ONSD/ICP determinations were performed, and repeated-measures correlation (rmcorr) and intra-individual correlations were analyzed. RESULTS The cohort correlation between US-ONSD and ICP was moderate (r = 0.504, p < 0.01). Rmcorr (r = 0.91, p < 0.01) and intra-individual correlations (r = 0.956-1) of US-ONSD and ICP were excellent. A mathematical regression equation can be calculated from two paired US-ONSD/ICP values and applied to the individual patient to approximate ICP from US-ONSD. CONCLUSIONS Related to excellent intra-individual correlations between US-ONSD and ICP, an individualized regression formula, created from two pairs of US-ONSD/ICP values, may be used to directly approximate ICP based on US-ONSD values. Hence, US-ONSD may become a non-invasive and reliable measure to control treatment efficacy in pediatric IIH.
Collapse
Affiliation(s)
- Susanne Regina Kerscher
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany; (J.Z.); (J.T.); (M.U.S.)
| | - Julian Zipfel
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany; (J.Z.); (J.T.); (M.U.S.)
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, 72076 Tuebingen, Germany; (A.B.); (K.H.-L.)
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, 72076 Tuebingen, Germany; (A.B.); (K.H.-L.)
| | - Jonas Tellermann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany; (J.Z.); (J.T.); (M.U.S.)
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany; (J.Z.); (J.T.); (M.U.S.)
| |
Collapse
|
3
|
Kerscher SR, Tellermann J, Zipfel J, Bevot A, Haas-Lude K, Schuhmann MU. Influence of sex and disease etiology on the development of papilledema and optic nerve sheath extension in the setting of intracranial pressure elevation in children. Brain Spine 2023; 4:102729. [PMID: 38510611 PMCID: PMC10951694 DOI: 10.1016/j.bas.2023.102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Abstract
Introduction Dilatation of the optic nerve sheath diameter and swelling of the optic disc are known phenomena associated with intracranial pressure elevation. Research question Do sex and disease etiology have an impact on the development of optic disc elevation and optic nerve sheath extension in children in the setting of ICP elevation? Fundoscopic papilledema and point-of-care-ultrasound techniques-optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE) - were compared in this regard. Material and methods 72 children were included in this prospective study; 50 with proven pathology (e.g. pseudotumor cerebri, tumor), 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array-transducer. This was compared with fundoscopic optic disc findings and in 28 patients with invasive ICP values, stratified for sex and etiology. Results In patients with proven disease, significant more girls (69%) had fundoscopic papilledema compared with boys (37%, p < 0.05). Girls had also larger US-ODE values (0.86 ± 0.36 mm vs. 0.65 ± 0.40 mm in boys). 80% of tumor patients had initial papilledema (100% girls, 79% boys), compared with 50% in pseudotumor cerebri (PTC) (83% girls, 30% boys). US-ONSD had no sex- and no etiology-specificity. Discussion and conclusion Presence of papilledema appears to be influenced by sex and etiology, whereas US-ONSD is not. Girls seem more likely to develop papilledema under similar conditions. Male sex and PTC appear as risk factors for being undetected by fundoscopic findings. US-ONSD and US-ODE seem useful tools to identify pathologies with potentially increased ICP requiring treatment in children regardless of sex and etiology.
Collapse
Affiliation(s)
- Susanne Regina Kerscher
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Jonas Tellermann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
| | - Julian Zipfel
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
| |
Collapse
|
4
|
Hirzallah MI, Bose S, Hu J, Maltz JS. Automation of ultrasonographic optic nerve sheath diameter measurement using convolutional neural networks. J Neuroimaging 2023; 33:898-903. [PMID: 37845814 DOI: 10.1111/jon.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Ultrasonographic optic nerve sheath (ONS) diameter is a noninvasive intracranial pressure (ICP) surrogate. ICP is monitored invasively in specialized intensive care units. Noninvasive ICP monitoring is important in less specialized settings. However, noninvasive ICP monitoring using ONS diameter (ONSD) is limited by the need for experts to obtain and perform measurements. We aim to automate ONSD measurements using a deep convolutional neural network (CNN) with a novel masking technique. METHODS We trained a CNN to reproduce masks that mark the ONS. The edges of the mask are defined by an expert. Eight models were trained with 1000 epochs per model. The Dice-similarity-coefficient-weighted averaged outputs of the eight models yielded the final predicted mask. Eight hundred and seventy-three images were obtained from 52 transorbital cine-ultrasonography sessions, performed on 46 patients with brain injuries. Eight hundred and fourteen images from 48 scanning sessions were used for training and validation and 59 images from four sessions for testing. Bland-Altman and Pearson linear correlation analyses were used to evaluate the agreement between CNN and expert measurements. RESULTS Expert ONSD measurements and CNN-derived ONSD estimates had strong agreement (r = 0.7, p < .0001). The expert mean ONSD (standard deviation) is 5.27 mm (0.43) compared to CNN mean estimate of 5.46 mm (0.37). Mean difference (95% confidence interval, p value) is 0.19 mm (0.10-0.27 mm, p = .0011), and root mean square error is 0.27 mm. CONCLUSION A CNN can learn ONSD measurement using masking without image segmentation or landmark detection.
Collapse
Affiliation(s)
- Mohammad I Hirzallah
- Departments of Neurology and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Baylor College of Medicine, Center for Space Medicine, Houston, Texas, USA
| | | | - Jingtong Hu
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
7
|
Abbinante G, Vitiello L, Coppola A, Salerno G, Gagliardi V, Pellegrino A. Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics (Basel) 2023; 13. [PMID: 36766639 DOI: 10.3390/diagnostics13030535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.
Collapse
|
8
|
Kaur N, Patro SK, Gupta AK, Chauhan N. Idiopathic Intracranial Hypertension and Endoscopic Optic Nerve Sheath Fenestration. Indian J Otolaryngol Head Neck Surg 2022; 74:972-975. [PMID: 36452828 PMCID: PMC9702139 DOI: 10.1007/s12070-020-02004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH), also called as benign intracranial hypertension is a disorder, which is considered benign in its course except its' ill effects on vision. Ocular findings in IIH such as papilledema, macular changes, retinal micro haemorrhages, cotton wool spots and tortuosity of vessels are the prominent features in funduscopy examination in these patients. Papilledema is a hallmark feature for evaluation of response to treatment. Ophthalmological rescue is a primary goal of management of idiopathic intracranial hypertension. Among the treatment options described in literature, optic nerve sheath fenestration is a minimally invasive endoscopic technique for the rescue of vision. We present this case-report, which will help ophthalmologists and the surgeons to determine the significance of the funduscopy changes after optic nerve sheath fenestration and help in decision making.
Collapse
Affiliation(s)
- Navjot Kaur
- Dept. of ENT and Head and Neck Surgery, PGIMER, Chandigarh, 160012 India
| | - Sourabha K. Patro
- Dept. of ENT and Head and Neck Surgery, PGIMER, Chandigarh, 160012 India
| | - Ashok K. Gupta
- Dept. of ENT and Head and Neck Surgery, PGIMER, Chandigarh, 160012 India
| | - Neha Chauhan
- Dept. of ENT and Head and Neck Surgery, PGIMER, Chandigarh, 160012 India
| |
Collapse
|
9
|
De Bernardo M, Vitiello L, De Luca M, La Marca A, Rosa N. Optic Nerve Changes Detected with Ocular Ultrasonography during Different Surgical Procedures: A Narrative Review. J Clin Med 2022; 11:jcm11185467. [PMID: 36143114 PMCID: PMC9500847 DOI: 10.3390/jcm11185467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of neurological and non-neurological conditions. Considering the latter, increases in intracranial pressure have also been described during several surgical procedures. Ocular ultrasonography might be utilized to identify intracranial pressure increases by evaluating optic nerve sheath diameter variations. The aim of this review is to provide a wide overview on the use of the optic nerve ultrasound evaluation to detect intracranial pressure changes during surgical procedures, also discussing the pitfalls of the B-scan technique, the most widely used for such a purpose. PubMed medical database, Web of Science and Scopus were used to carry out this review. The present review showed that ocular ultrasonography could be considered a valuable diagnostic tool in the surgical setting to indirectly assess intracranial pressure. However, the use of the B-scan ultrasound should always be coupled with the standardized A-scan technique for a more accurate, precise and trustworthy ultrasound assessment.
Collapse
|
10
|
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: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
12
|
De Bernardo M, Vitiello L, De Pascale I, Capasso L, Cornetta P, Rosa N. Optic Nerve Ultrasound Evaluation in Idiopathic Intracranial Hypertension. Front Med (Lausanne) 2022; 9:845554. [PMID: 35299843 PMCID: PMC8921495 DOI: 10.3389/fmed.2022.845554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 01/27/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disease with a heterogeneity of possible causes, which needs to be quickly diagnosed. Ocular ultrasonography could be considered a useful tool to diagnose this condition in a fast and non-invasive way. In fact, Karl Ossoinig had already proposed this diagnostic tool in the 1970s for the evaluation of intracranial pressure changes under several pathological conditions, including idiopathic intracranial hypertension. The aim of this review is to analyze scientific articles published in the last 30 years concerning the use of ocular ultrasonography to assess optic nerve indices in patients with idiopathic intracranial hypertension. Specifically, 15 published articles found in PubMed database were included and analyzed in the present review. Our conclusion suggests that ocular ultrasonography is a reliable diagnostic technique to be utilized in all the cases of suspected raised intracranial pressure. To obtain the best possible accuracy and precision in the least invasive way, standardized A-scan seems to be the best choice.
Collapse
Affiliation(s)
- Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Livio Vitiello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Ilaria De Pascale
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, Azienda Sanitaria Locale Napoli 1, Naples, Italy
| | - Palmiro Cornetta
- Eye Unit, "Maria SS Addolorata" Hospital, Azienda Sanitaria Locale Salerno, Salerno, Italy
| | - Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana, " University of Salerno, Salerno, Italy
| |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
14
|
Kerscher SR, Zipfel J, Groeschel S, Bevot A, Haas-Lude K, Schuhmann MU. Comparison of B-Scan Ultrasound and MRI-Based Optic Nerve Sheath Diameter ( ONSD) Measurements in Children. Pediatr Neurol 2021; 124:15-20. [PMID: 34508997 DOI: 10.1016/j.pediatrneurol.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2021] [Accepted: 08/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Qualitative, noninvasive assessment of intracranial pressure is of eminent importance in pediatric patients in many clinical situations and can reliably be performed using transorbital ultrasonographic measurement of the optic nerve sheath diameter (ONSD). MRI-based determination of ONSD can serve as an alternative if ultrasound (US) is not possible or available for various reasons, for example, in small, incompliant children. This study investigates repeatability and observer reliability of US ONSD and correlation and bias of US- versus MRI-based ONSD assessment in pediatric patients. METHODS One hundred fifty children diagnosed with tumor (n = 40), hydrocephalus (n = 42), and other cranial pathologies (n = 68) were included. Bilateral ONSD was quantified by US using a 12-MHz linear array transducer. This was compared with ONSD measured in simultaneously acquired (≤24 h) T2-weighted MRI scans of the orbit. RESULTS Repeatability of individual US values and intraobserver ONSD was outstanding (Cronbach's α = 0.984 and 0.996, respectively). Overall mean values for ONSD were 5.8 ± 0.88 mm and 5.7 ± 0.89 mm for US and MRI, respectively. Correlation between US and MRI-based ONSD was strong (r = 0.976, P < 0.01). Bland and Altman analysis showed a mean bias of 0.078 mm. A repeated-measures correlation (rrm) in 9 patients showed an excellent value (rrm = 0.94, P < 0.01). CONCLUSIONS Repeatability and reliability of US ONSD determination is excellent. In case US ONSD assessment is not possible or available, MRI scans can serve as an excellent alternative. The difference of US and MRI ONSD is minimal and insignificant, and thus, both techniques can complement each other.
Collapse
Affiliation(s)
- Susanne R Kerscher
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany.
| | - Julian Zipfel
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Samuel Groeschel
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Martin U Schuhmann
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| |
Collapse
|
15
|
Weidner N, Kretschmann J, Bomberg H, Antes S, Leonhardt S, Tschan C, Oertel J, Volk T, Meiser A, Groesdonk HV. Real-Time Evaluation of Optic Nerve Sheath Diameter ( ONSD) in Awake, Spontaneously Breathing Patients. J Clin Med 2021; 10:3549. [PMID: 34441846 DOI: 10.3390/jcm10163549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values. (2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in 25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm, accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2, ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity 90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously breathing patients provides a valuable method to evaluate patients with suspected increased ICP. Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify patients at risk for a poor neurological outcome.
Collapse
|
16
|
Maissan IM, Vlottes B, Hoeks S, Bosch J, Stolker RJ, den Hartog D. Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study. Scand J Trauma Resusc Emerg Med 2021; 29:87. [PMID: 34193207 PMCID: PMC8246666 DOI: 10.1186/s13049-021-00904-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position. METHODS Participants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30° upright position. RESULTS Mean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80-5.00) mm during normal transportation to 6.00 (IQR 5.75-6.40) mm (p < 0.001) during braking. ONSD's increased in all subjects in supine position. After raising the headrest of the gurney 30° mean ONSD increased from 4.80 (IQR 4.67-5.02) mm during normal transportation to 4.90 (IQR 4.80-5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all. CONCLUSIONS ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.
Collapse
Affiliation(s)
- Iscander M Maissan
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - Boris Vlottes
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Sanne Hoeks
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Jan Bosch
- Regionale Ambulancevoorziening Hollands Midden, Research and Development, Vondellaan 43, 2332AA, Leiden, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Department of Trauma Surgery, Dr. Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
17
|
Stevens RRF, Huberts W, Gommer ED, Ertl M, Aries M, Mess WH, Delhaas T. An Automated Algorithm for Optic Nerve Sheath Diameter Assessment from B-mode Ultrasound Images. J Neuroimaging 2021; 31:724-732. [PMID: 33783910 DOI: 10.1111/jon.12851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE The optic nerve sheath diameter (ONSD) is a promising surrogate marker for the detection of raised intracranial pressure (ICP). However, inconsistencies in manual ONSD assessment are thought to affect ONSD and the corresponding ONSD cutoff values for the diagnosis of elevated ICP, hereby hampering the full potential of ONSD. In this study, we developed an image intensity-invariant algorithm to automatically estimate ONSD from B-mode ultrasound images at multiple depths. METHODS The outcomes of the algorithm were validated against manual ONSD measurements by two human experts. Each expert analyzed the images twice (M1 and M2) in unknown order. RESULTS The algorithm proved capable of segmenting the ONSD in 39 of 42 images, hereby showing mean differences of -.08 ± .45 and -.05 ± .41 mm compared to averaged ONSD values (M1 + M2/2) of Operator 1 and Operator 2, respectively, whereas the mean difference between the two experts was .03 ± .26 mm. Moreover, differences between algorithm-derived and expert-derived ONSD values were found to be much smaller than the 1 mm difference that is expected between patients with normal and elevated ICP, making it likely that our algorithm can distinguish between these patient groups. CONCLUSIONS Our algorithm has the potential to improve the accuracy of ONSD as a surrogate marker for elevated ICP because it has no intrinsic variability. However, future research should be performed to validate if the algorithm does indeed result in more accurate noninvasive ICP predictions.
Collapse
Affiliation(s)
- Raoul R F Stevens
- Department of Biomedical Engineering, MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Erik D Gommer
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Marcel Aries
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
18
|
Huo SC, Gibbons RC, Costantino TG. Utility of Point-of-Care Ultrasound in the Diagnosis of Idiopathic Intracranial Hypertension in the Emergency Department. J Emerg Med 2020; 60:210-215. [PMID: 33097355 DOI: 10.1016/j.jemermed.2020.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/07/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency physicians are frequently required to identify and triage patients with increased intracranial pressure (ICP). Idiopathic intracranial hypertension (IIH) is a possible cause that must be considered. Its prognosis depends on prompt recognition and treatment, and progression of the disease can lead to permanent vision loss and considerable morbidity. Point-of-care ultrasound can rapidly identify elevated ICP. Measurements of the optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) can act as surrogates for ICP. CASE SERIES We describe five cases in which ultrasound was used to identify increased ICP and aid clinical decision-making. In several of the cases, ultrasound was used to confirm a suspicion for IIH and initiate therapy while awaiting the results of a more time-consuming and technically challenging test, such as lumbar puncture or optical coherence tomography. One of the patients was pregnant, and sonographic evidence of elevated ICP helped avoid exposing the patient to unnecessary radiation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound is a quick and versatile tool for screening patients with neurologic symptoms, and when integrated into the proper clinical context, can reduce the use of more invasive tests. It can be particularly useful in patients with pathology that may not show abnormalities on computed tomography scan or in whom lumbar puncture is technically difficult, making patients at risk for IIH well-suited to examination by ultrasound. We use a cutoff of 5 mm for ONSD and 0.6 mm for ODE, though there are no universally agreed on cutoff values.
Collapse
Affiliation(s)
| | - Ryan C Gibbons
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Thomas G Costantino
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
19
|
Schroeder C, Katsanos AH, Ayzenberg I, Schwake C, Gahlen A, Tsivgoulis G, Voumvourakis K, Gold R, Krogias C. Atrophy of optic nerve detected by transorbital sonography in patients with demyelinating diseases of the central nervous system. Eur J Neurol 2019; 27:626-632. [PMID: 31814240 DOI: 10.1111/ene.14137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Transorbital sonography (TOS) has emerged as promising imaging method for the diagnosis and follow-up of acute optic neuritis (ON). Available studies report an increase in the optic nerve diameter (OND) and the optic nerve sheath diameter (ONSD) in the case of a first episode of ON in the affected eye compared to either the contralateral unaffected eye or controls. However, the utility of TOS in the case of recurrent episodes of ON has never been assessed. METHODS In our prospective cohort study, the diagnostic utility of TOS in patients with demyelinating diseases of the central nervous system was assessed, and the association between TOS, optical coherence tomography (OCT) and visual evoked potentials was examined further. RESULTS Seventy-eight patients with a history of demyelinating disorders of the central nervous system (mean age 38.2 ± 14.2 years; 24% with acute ON) were included. No differences in the OND (3.2 ± 0.5 mm vs. 3.2 ± 0.4 mm) and ONSD (5.1 ± 0.8 mm vs. 5.1 ± 0.7 mm) measurements were found between patients with and without acute ON. Papillary swelling was more frequent in patients with acute ON (14.2% vs. 1.5%, P = 0.002). Patients with a history of previous ON were found to have lower OND (P < 0.001) and ONSD (P = 0.007) compared to patients without a history of previous ON. TOS measurements were inversely associated with disease duration and positively correlated with OCT findings. No association with visual evoked potential measurements was found. CONCLUSION No evidence was found for TOS-sensitive differences in the OND and ONSD of patients with demyelinating diseases, according to the presence of acute ON. The association between TOS and OCT measurements deserves further investigation.
Collapse
Affiliation(s)
- C Schroeder
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A H Katsanos
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany.,Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Ayzenberg
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany.,Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - C Schwake
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Gahlen
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - G Tsivgoulis
- Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - K Voumvourakis
- Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R Gold
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - C Krogias
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| |
Collapse
|
20
|
Avci M, Kozaci N, Komut E, Komut S, Caliskan G, Tulubas G. The Measurement of Elderly Volunteers' Optic Nerve Sheath Diameters by Ocular Ultrasonography. ACTA ACUST UNITED AC 2019; 55:medicina55080413. [PMID: 31357667 PMCID: PMC6724037 DOI: 10.3390/medicina55080413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP. MATERIALS AND METHODS The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65-74 years of age; Group 2: 75-84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared. RESULTS The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups. CONCLUSIONS In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.
Collapse
Affiliation(s)
- Mustafa Avci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, 07100 Antalya, Turkey.
| | - Nalan Kozaci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, 07100 Antalya, Turkey
| | - Erdal Komut
- Department of Radiology, Hitit University Medical School, 19040 Corum, Turkey
| | - Seval Komut
- Department of Emergency Medicine, Hitit University Medical School, 19040 Corum, Turkey
| | - Gulsum Caliskan
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, 07100 Antalya, Turkey
| | - Gul Tulubas
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, 07100 Antalya, Turkey
| |
Collapse
|
21
|
Wang J, Li K, Li H, Ji C, Wu Z, Chen H, Chen B. Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg 2019; 133:514-520. [PMID: 31323632 DOI: 10.3171/2019.4.jns183297] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Increased intracranial pressure (ICP) results in enlarged optic nerve sheath diameter (ONSD). In this study the authors aimed to assess the association of ONSD and ICP in severe traumatic brain injury (TBI) after decompressive craniotomy (DC). METHODS ONSDs were measured by ocular ultrasonography in 40 healthy control adults. ICPs were monitored invasively with a microsensor at 6 hours and 24 hours after DC operation in 35 TBI patients. ONSDs were measured at the same time in these patients. Patients were assigned to 3 groups according to ICP levels, including normal (ICP ≤ 13 mm Hg), mildly elevated (ICP = 14-22 mm Hg), and severely elevated (ICP > 22 mm Hg) groups. ONSDs were compared between healthy control adults and TBI cases with DC. Then, the association of ONSD with ICP was analyzed using Pearson's correlation coefficient, linear regression analysis, and receiver operator characteristic curves. RESULTS Seventy ICP measurements were obtained among 35 TBI patients after DC, including 25, 27, and 18 measurements in the normal, mildly elevated, and severely elevated ICP groups, respectively. Mean ONSDs were 4.09 ± 0.38 mm in the control group and 4.92 ± 0.37, 5.77 ± 0.41, and 6.52 ± 0.44 mm in the normal, mildly elevated, and severely elevated ICP groups, respectively (p < 0.001). A significant linear correlation was found between ONSD and ICP (r = 0.771, p < 0.0001). Enlarged ONSD was a robust predictor of elevated ICP. With an ONSD cutoff of 5.48 mm (ICP > 13 mm Hg), sensitivity and specificity were 91.1% and 88.0%, respectively; a cutoff of 5.83 mm (ICP > 22 mm Hg) yielded sensitivity and specificity of 94.4% and 81.0%, respectively. CONCLUSIONS Ultrasonographic ONSD is strongly correlated with invasive ICP measurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after DC.
Collapse
Affiliation(s)
- Juxiang Wang
- 1Department of Intensive Care Unit, Xiamen Cardiovascular Hospital, Xiamen University
- 2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine
| | - Ke Li
- 3Department of Intensive Care Unit, Xiang'an Hospital of Xiamen University
| | - Hongjia Li
- 4Department of Neurosurgery, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine; and
| | - Chengyi Ji
- 2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine
| | - Ziyao Wu
- 2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine
| | - Huimin Chen
- 2Department of Intensive Care Unit, Third Hospital of Xiamen Affiliated of Fujian University of Traditional Chinese Medicine
| | - Bin Chen
- 5Department of Healthcare, Xiamen Port Clinic of Xiamen Customs, Xiamen, Fujian, China
| |
Collapse
|
22
|
Demir TA, Yılmaz F, Sönmez BM, Karadaş MA, Okudan RN, Keskin O. Association of optic nerve sheath diameter measurement with hyponatremia in emergency department. Am J Emerg Med 2019; 37:1876-9. [PMID: 30622006 DOI: 10.1016/j.ajem.2018.12.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Investigation of association of ONSD with hyponatremia in symptomatic patients. METHODS 89 patients who were diagnosed to have hyponatremia (Na + <135 mmol/L) were prospectively analyzed and compared with 72 patients who have normal serum sodium levels presented to ED at the same time interval. Subjects' demographic properties including age and sex were recorded, as were admission symptoms, serum Na + level, and pre-treatment and post-treatment optic nerve sheath diameter (ONSD). RESULTS The mean age of the study population was 62.3 ± 17.6 years, and the control group 55.1 ± 20.0 years (p < 0.05). There was a significant difference between the patient group's pre-treatment and post-treatment OSNDs compared to the controls (p < 0.05). There was a significant negative correlation between the admission sodium level and ONSD in the patient group (p < 0.05). In the pre-treatment period, patients with symptoms had a significantly greater mean ONSD than those without symptoms (0.546 ± 0.068 mm vs 0.448 ± 0.081 mm; p < 0.05). The area under the curve was 0.870; the cut-off level calculated for hyponatremia was 0.49 mm, which had a sensitivity of 81% and a specificity of 81.9%. CONCLUSION Ultrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.
Collapse
|
23
|
Jeziorny K, Niwald A, Moll A, Piasecka K, Pyziak-Skupien A, Waszczykowska A, Baranska D, Malachowska B, Szadkowska A, Mlynarski W, Zmyslowska A. Measurement of corneal thickness, optic nerve sheath diameter and retinal nerve fiber layer as potential new non-invasive methods in assessing a risk of cerebral edema in type 1 diabetes in children. Acta Diabetol 2018; 55:1295-1301. [PMID: 30327872 PMCID: PMC6244862 DOI: 10.1007/s00592-018-1242-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/05/2018] [Indexed: 01/17/2023]
Abstract
AIMS Some patients with diabetic ketoacidosis develop cerebral edema (CE) in the course of type 1 diabetes mellitus (T1D), which may result in central nervous system disorders and high mortality. The imperfection of existing neuroimaging techniques for early recognition of CE forces us to search for the new and non-invasive methods. The aim of the study was to assess the usefulness of new methods (pachymetry, transorbital ultrasonography-USG, optical coherence tomography-OCT study) in the assessment of the risk of CE occurrence in children with newly diagnosed T1D. METHODS The study group included 50 children with newly diagnosed T1D, 54 patients with long-term T1D as a reference group and 40 children without glucose tolerance disorders as controls. In all subjects, a corneal thickness (CCT) index with pachymeter, optic nerve sheath diameter (ONSD) using transorbital USG and retinal nerve fiber layer (RNFL) during OCT study were measured and compared with selected clinical parameters of T1D. RESULTS In patients from a study group at onset of T1D, the higher CCT (p < 0.001) and ONSD (p < 0.001) values were observed as compared to the results obtained after 48 h of metabolic compensation. The ONSD correlated negatively with pH value (r = - 0.64; p < 0.001), BE (r = - 0.54, p < 0.001) and HCO3- (r = - 0.50; p < 0.001). A positive correlation between RNFL and Na+ levels (r = 0.47; p < 0.005) was also observed. CONCLUSIONS Transorbital USG and pachymetry may serve as the potential promising methods for the non-invasive assessment of the increased risk of development of CE in patients with T1D.
Collapse
Affiliation(s)
- Krzysztof Jeziorny
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland
| | - Anna Niwald
- Outpatient Clinic of Pediatric Ophthalmology, Central Clinical Hospital, Lodz, Poland
| | - Agnieszka Moll
- Outpatient Clinic of Pediatric Ophthalmology, Central Clinical Hospital, Lodz, Poland
| | - Katarzyna Piasecka
- Outpatient Clinic of Pediatric Ophthalmology, Central Clinical Hospital, Lodz, Poland
| | - Aleksandra Pyziak-Skupien
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland
| | - Arleta Waszczykowska
- Department of Ophthalmology and Vision Rehabilitation, Medical University of Lodz, Lodz, Poland
| | - Dobromiła Baranska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Beata Malachowska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland
| | - Agnieszka Zmyslowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland.
| |
Collapse
|
24
|
Sönmez BM, Temel E, İşcanlı MD, Yılmaz F, Gülöksüz U, Parlak S, Uçkun ÖM. Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments? J Natl Med Assoc 2018; 111:210-217. [PMID: 30415927 DOI: 10.1016/j.jnma.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/11/2018] [Accepted: 10/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emergency departments (EDs) are typically the first medical contact for patients with traumatic brain injury (TBI) and early diagnosis and treatment of intracranial pressure (ICP) in patients with neurotrauma primarily falls under the liability of emergency doctors. Monitoring ICP with optic nerve sheath diameter (ONSD) via tools has gained popularity among emergency service doctors. In this study, we aimed to evaluate the predictive value of ONSD for specific head injury on initial cranial tomography. METHODS CT scans of 176 patients with a known intracranial pathology were retrospectively analyzed and compared with normal control CTs of 182 patients presented to ED at the same time interval. The attending radiologist analyzed all initial brain CT scans and randomly sampled control CTs were similarly assessed by the second senior radiologist whom were blind to the patients' medical histories and circumstances of TBI at the time of measurement. ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera. RESULTS Right ONSD value was significantly higher in patients with herniation and SAH (p = 0,024 and 0,028, respectively). Left ONSD values was at the level of statistical significance and mean ONSD values was significantly higher in patients with SAH (p = 0.05 and 0.026, respectively). Right-left-mean ONSD values were statistically higher in study group with bilateral lesions on brain CT (p < 0,001). ONSD measurements and patient age were higher in patients who died (p < 0,001). CONCLUSIONS ONSD measurement on initial brain CT is lesion dependent and indicates mortality.
Collapse
Affiliation(s)
- Bedriye Müge Sönmez
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey.
| | - Emirhan Temel
- Ankara Numune Education and Research Hospital; Department of Radiology, Ankara, Turkey
| | - Murat Doğan İşcanlı
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Fevzi Yılmaz
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Uğur Gülöksüz
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Selçuk Parlak
- Ankara Numune Education and Research Hospital; Department of Radiology, Ankara, Turkey
| | - Özhan Merzuk Uçkun
- Ankara Numune Education and Research Hospital; Department of Neurosurgery, Ankara, Turkey
| |
Collapse
|
25
|
Kayhanian S, Young AMH, Piper RJ, Donnelly J, Scoffings D, Garnett MR, Fernandes HM, Smielewski P, Czosnyka M, Hutchinson PJ, Agrawal S. Radiological Correlates of Raised Intracranial Pressure in Children: A Review. Front Pediatr 2018; 6:32. [PMID: 29527519 PMCID: PMC5829037 DOI: 10.3389/fped.2018.00032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/05/2018] [Indexed: 01/22/2023] Open
Abstract
Radiological assessment of the head is a routine part of the management of traumatic brain injury. This assessment can help to determine the requirement for invasive intracranial pressure (ICP) monitoring. The radiological correlates of elevated ICP have been widely studied in adults but far fewer specific pediatric studies have been conducted. There is, however, growing evidence that there are important differences in the radiological presentations of elevated ICP between children and adults; a reflection of the anatomical and physiological differences, as well as a difference in the pathophysiology of brain injury in children. Here in, we review the radiological parameters that correspond with increased ICP in children that have been described in the literature. We then describe the future directions of this work and our recommendations in order to develop non-invasive and radiological markers of raised ICP in children.
Collapse
Affiliation(s)
- Saeed Kayhanian
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Adam M. H. Young
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Rory J. Piper
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Joseph Donnelly
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Daniel Scoffings
- Department of Neuroradiology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Matthew R. Garnett
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Helen M. Fernandes
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter Smielewski
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Marek Czosnyka
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shruti Agrawal
- Department of Paediatric Intensive Care, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
26
|
Zewdie A, Tesema H, Aklilu AT, Teklemariam TL, Zewdu T, Ashagre Y, Bizuneh Y, Azazh A, Hassen GW. Bedside ultrasound as a simple non-invasive method of assessing intracranial pressure in a limited resource setting. Afr J Emerg Med 2016; 6:e1-4. [PMID: 30456086 DOI: 10.1016/j.afjem.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 05/26/2016] [Accepted: 06/19/2016] [Indexed: 01/02/2023] Open
Abstract
Introduction Increased intracranial pressure is usually measured with invasive methods that are not practical in resource-limited countries. However, bedside ultrasound, a non-invasive method, measures the optic nerve sheath diameter and could be a safe and accurate alternative to measure intracranial pressure, even in children. Case report We report a case of a 15-year old patient who presented with severe headache, projectile vomiting, and neck pain for two months. The bedside ultrasound showed a 10 mm optic nerve sheath diameter and a Computed Tomography scan of her brain revealed obstructive hydrocephalus secondary to a mass in the fourth ventricle. After intervening, we were able to monitor the decrease in her optic nerve sheath diameter with ultrasound. Conclusion Performing invasive procedures continues to be a challenge in the resource limited setting. However, bedside ultrasound can be a useful tool in emergency centres for early detection and monitoring of intracranial pressure.
Collapse
|
27
|
Maissan IM, Dirven PJAC, Haitsma IK, Hoeks SE, Gommers D, Stolker RJ. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg 2015; 123:743-7. [PMID: 25955869 DOI: 10.3171/2014.10.jns141197] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECT Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD. Therefore, the authors researched whether ONSD and ICP simultaneously change during tracheal manipulation in patients in the intensive care unit (ICU) who have suffered a traumatic brain injury (TBI). MATERIALS The authors included 18 ICP-monitored patients who had sustained TBI and were admitted to the ICU. They examined the optic nerve sheath by performing ultrasound before, during, and after tracheal manipulation, which is known to increase ICP. The correlation between ONSD and ICP measurements was determined, and the diagnostic performance of ONSD measurement was tested using receiver operating characteristic curve analysis. RESULTS In all patients ICP increased above 20 mm Hg during manipulation of the trachea, and this increase was directly associated with a dilation of the ONSD of > 5.0 mm. After tracheal manipulation stopped, ICP as well as ONSD decreased immediately to baseline levels. The correlation between ICP and ONSD was high (R(2) = 0.80); at a cutoff of ≥ 5.0 mm ONSD, a sensitivity of 94%, a specificity of 98%, and an area under the curve of 0.99 (95% CI 0.97-1.00) for detecting elevated ICP were determined. CONCLUSIONS In patients who have sustained a TBI, ultrasonography of the ONSD is an accurate, simple, and rapid measurement for detecting elevated ICP as well as immediate changes in ICP. Therefore, it might be a useful tool to monitor ICP, especially in conditions in which invasive ICP monitoring is not available, such as at trauma scenes.
Collapse
Affiliation(s)
| | | | | | | | - Diederik Gommers
- Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|