A Narrative Review of Point of Care Ultrasound Assessment of the Optic Nerve in Emergency Medicine

Lau, Torey; Ahn, JoongHo; Manji, Rahim; Kim, Daniel

doi:10.3390/life13020531

Cited by 6 publications

(4 citation statements)

References 63 publications

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“…A meta-analysis in 2023 pooled six articles on the association between ONSD and AMS symptoms. The majority of studies showed that ONSD was increased during ascent regardless of AMS or not (Lau et al, 2023). In our results, we find that increased ONSD values were observed in both HM and non-HM trekkers from ground to 1,700 m. Our data, although far from conclusive, provide additional information regarding ocular physiological responses at high altitudes.…”

Section: Changes In Onsd Between Groups With and Without Hm Exposure ...contrasting

confidence: 39%

“…The optic nerve sheath is an extension of the dura mater and contains subarachnoid CSF. Sonographic measurement of optic nerve sheath diameter (ONSD) has multiple clinical applications, including detection of increased intracranial pressure, optic neuritis, and AMS (Lau et al, 2023). Lau et al conducted a meta-analysis assessing the ONSD and AMS.…”

Section: Introductionmentioning

confidence: 99%

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High myopia at high altitudes

Wang,

Huang,

Hsu

et al. 2024

Front. Physiol.

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Background: Optic nerve sheath diameter (ONSD) increases significantly at high altitudes, and is associated with the presence and severity of acute mountain sickness (AMS). Exposure to hypobaria, hypoxia, and coldness when hiking also impacts intraocular pressure (IOP). To date, little is known about ocular physiological responses in trekkers with myopia at high altitudes. This study aimed to determine changes in the ONSD and IOP between participants with and without high myopia (HM) during hiking and to test whether these changes could predict symptoms of AMS.Methods: Nine participants with HM and 18 without HM participated in a 3-day trek of Xue Mountain. The ONSD, IOP, and questionnaires were examined before and during the trek of Xue Mountain.Results: The ONSD values increased significantly in both HM (p = 0.005) and non-HM trekkers (p = 0.018) at an altitude of 1,700 m. In the HM group, IOP levels were greater than those in the non-HM group (p = 0.034) on the first day of trekking (altitude: 3,150 m). No statistically significant difference was observed between the two groups for the values of ONSD. Fractional changes in ONSD at an altitude of 1,700 m were related to the development of AMS (rpb = 0.448, p = 0.019) and the presence of headache symptoms (rpb = 0.542, p = 0.004). The area under the ROC curve for the diagnostic performance of ONSD fractional changes at an altitude of 1,700 m was 0.859 for predicting the development of AMS and 0.803 for predicting the presence of headache symptoms.Conclusion: Analysis of changes in ONSD at moderate altitude could predict AMS symptoms before an ascent to high altitude. Myopia may impact physiological accommodation at high altitudes, and HM trekkers potentially demonstrate suboptimal regulation of aqueous humor in such environments.

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Section: Changes In Onsd Between Groups With and Without Hm Exposure ...contrasting

confidence: 39%

Section: Introductionmentioning

confidence: 99%

High myopia at high altitudes

Wang,

Huang,

Hsu

et al. 2024

Front. Physiol.

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“…Ocular POCUS has demonstrated utility and has been validated for the measurement of optic nerve sheath diameter (ONSD) in adults, allowing for the assessment of ICP [7]. However, in pediatric populations no consensus exists on normal pediatric ONSD values.…”

Section: Discussionmentioning

confidence: 99%

Optic Disc Elevation Secondary to Cerebral Malaria Resolves Completely With Mannitol Administration and Corresponds to Clinical Improvement

Douglas-Vail,

Fah,

Cotran-Lenrow

et al. 2023

Cureus

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This case report describes a 14-year-old boy presenting with cerebral malaria in a resource-limited setting. The patient exhibited optic disc elevation, indicating increased intracranial pressure (ICP). Due to the unavailability of advanced neuroimaging, point-of-care ultrasound (POCUS) was employed to assess the optic disc. After administration of a weight-based dose of mannitol, optic disc elevation resolved completely, accompanied by clinical improvement. This case highlights the potential of POCUS as a valuable tool for the assessment and management of cerebral malaria in resource-limited settings.

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“…Ultrasound measurements of ONSD have the potential to be more reliable than clinical assessments in the diagnosis of ICP. The study suggested that the approach might be used as an emergency procedure to identify elevated ICP [ 37 ].…”

Section: Reviewmentioning

confidence: 99%

Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review

Koshy,

Gadkari

2024

Cureus

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The aim of this review article is to outline the effectiveness of using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) in order to identify variations in intracranial pressure (ICP) and subsequently avoid the complication of secondary brain injury in patients with traumatic brain injury (TBI), who are admitted to an emergency department (ED). Reputable publications and numerous studies demonstrate the problem's exponential rampancy and pervasiveness. In a TBI patient, the emergence of secondary brain damage has been recognized as a serious emergency. It is believed that secondary brain damage is caused by an abnormally high ICP. High levels of ICP can be measured using both invasive and non-invasive approaches. ONSD measurement via bedside ultrasound has been identified as a quick, useful technique to be used in the ED to avoid potential morbidity and mortality owing to secondary brain injury.

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A Narrative Review of Point of Care Ultrasound Assessment of the Optic Nerve in Emergency Medicine

Cited by 6 publications

References 63 publications

High myopia at high altitudes

High myopia at high altitudes

Optic Disc Elevation Secondary to Cerebral Malaria Resolves Completely With Mannitol Administration and Corresponds to Clinical Improvement

Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review

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