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Background: Elevated intracranial pressure is a complication of several traumatic as well as non-traumatic medical conditions. Clinical diagnosis can be difficult as it may present with non-specific complaints such as headache, vomiting, blurred vision, vomiting and altered sensorium. The expertise to perform ophthalmoscopy is not always immediately available in emergency rooms and the access to cross sectional imaging may be limited. Distention of the optic nerve sheath is an early sign of raised ICP as it is in direct communication with the subarachnoid space. Ultrasound is a widely available tool in emergency situations which can be used to measure the optic nerve sheath diameter (ONSD).Methods: In this prospective observational study, 36 patients suspected of having elevated intracranial pressure underwent high resolution B-scan ultrasound to measure the ONSD. Further, patients underwent CT scan of head and were evaluated for signs of raised ICT. Sensitivity and specificity of B-scan measurement of ONSD with CT scan was compared.Results: The ONSD measurement was 88.5% sensitive (95% CI 68% to 97%) and 90% specific (95% CI 55% to 99%) with CT as the reference.Conclusions: Bedside ultrasound B-scan measurement of the optic nerve sheath diameter provides information about raised intracranial pressure with a high sensitivity and specificity.

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Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings. Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia. Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on. Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.