A-Scan Ultrasonographic Evaluation of Patients with Idiopathic Intracranial Hypertension: Comparison of Optic Nerves

Rosa, Nicola; Bernardo, Maddalena De; Stasi, Margherita Di; Cione, Ferdinando; Capaldo, Ilaria

doi:10.3390/jcm11206153

Cited by 25 publications

(14 citation statements)

References 30 publications

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“…A study has pointed out that when evaluating the optic nerve sheath, the standardized A-scan has some advantages. (Rosa et al, 2022b). Moreover, more in-depth research is needed.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure

et al. 2023

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Background/aim: Patients with elevated intracranial pressure (ICP) tend to have optic disc edema and a thicker optic nerve sheath diameter (ONSD). However, the cut-off value of the optic disc height (ODH) for evaluating elevated ICP is not clear. This study was conducted to evaluate ultrasonic ODH and to investigate the reliability of ODH and ONSD for elevated ICP.Methods: Patients suspected of having increased ICP and who underwent a lumbar puncture were recruited. ODH and ONSD were measured before lumbar puncture. Patients were divided according to elevated and normal ICP. We analyzed the correlations between ODH, ONSD, and ICP. ODH and ONSD cut-off points for the identification of elevated ICP were determined and compared.Results: There were a total of 107 patients recruited for this study, 55 patients with elevated ICP and 52 with normal ICP. Both ODH and ONSD in the elevated ICP group were higher than in the normal group [ODH: median 0.81 (range 0.60–1.06) mm vs. 0.40 [0–0.60] mm, p < 0.001; ONSD: 5.01 ± 0.37 mm vs. 4.20 ± 0.38 mm, p < 0.001]. ICP was positively correlated with ODH (r = 0.613; p < 0.001) and ONSD (r = 0.792; p < 0.001). The cut-off values of ODH and ONSD for evaluating elevated ICP were 0.63 mm and 4.68 mm, respectively, with 73% and 84% sensitivity and 83% and 94% specificity, respectively. ODH combined with ONSD showed the highest value under the receiver operating characteristic curve of 0.965 with a sensitivity of 93% and a specificity of 92%.Conclusion: Ultrasonic ODH combined with ONSD may help monitor elevated ICP non-invasively.

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“…A study has pointed out that when evaluating the optic nerve sheath, the standardized A-scan has some advantages. (Rosa et al, 2022b). Moreover, more in-depth research is needed.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure

et al. 2023

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“…This is caused due to the changes in the position of the eyeball which can lead to variations in the amount of cerebrospinal fluid (CSF) surrounding the optic nerve, resulting in different ONSD values. Another study by Rosa et al 36 utilized A-scan ultrasonography to assess the relationship between both eyes and found a statistically significant difference ( p < .001) in ONSD values between the two eyes, without a clear dominance, in both normal and idiopathic intracranial hypertension (IIH) patients. This indicates that asymmetry exists in both eyes and suggests the importance of evaluating both eyes in ONSD measurements.…”

Section: Discussionmentioning

confidence: 99%

A Novel Method for Prediction of Raised Intracranial Pressure Through Automated ONSD and ETD Ratio Measurement From Ocular Ultrasound

Singh,

Gupta,

Gupta

et al. 2023

Ultrason Imaging

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The paper presents a novel framework for the prediction of the raised Intracranial Pressure (ICP) from ocular ultrasound images of traumatic patients through automated measurement of Optic Nerve Sheath Diameter (ONSD) and Eyeball Transverse Diameter (ETD). The measurement of ONSD using an ocular ultrasound scan is non-invasive and correlates with the raised ICP. However, the existing studies suggested that the ONSD value alone is insufficient to indicate the ICP condition. Since the ONSD and ETD values may vary among patients belonging to different ethnicity/origins, there is a need for developing an independent global biomarker for predicting raised ICP condition. The proposed work develops an automated framework for the prediction of raised ICP by developing algorithms for the automated measurement of ONSD and ETD values. It is established that the ONSD and ETD ratio (OER) is a potential biomarker for ICP prediction independent of ethnicity and origin. The OER threshold value is determined by performing statistical analysis on the data of 57 trauma patients obtained from the AIIMS, New Delhi. The automated OER is computed and compared with the conventionally measured ICP by determining suitable correlation coefficients. It is found that there is a significant correlation of OER with ICP ( r = .81, p ≤ .01), whereas the correlation of ONSD alone with ICP is relatively less ( r = .69, p = .004). These correlation values indicate that OER is a better parameter for the prediction of ICP. Further, the threshold value of OER is found to be 0.21 for predicting raised ICP conditions in this study. Scatter plot and Heat map analysis of OER and corresponding ICP reveal that patients with OER ≥ 0.21, have ICP in the range of 17 to 35 mm Hg. In the data available for this research work, OER ranges from 0.17 to 0.35.

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“…B-scans can have potential variations resulting in a so-called ‘blooming’ effect, affecting measurement accuracy [36]. A-scans are recommended but can be difficult to interpret [37].…”

Section: Diagnosticsmentioning

confidence: 99%

Idiopathic intracranial hypertension: expanding our understanding

Markey,

Hutchcroft,

Emsley

2023

Current Opinion in Neurology

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Purpose of review Idiopathic intracranial hypertension (IIH) affects predominantly overweight women of childbearing age, causing chronically disabling headaches and visual loss. Weight loss remains the most effective management strategy, but innovative treatments and randomized control trials (RCTs) remain few. This paper will review recent IIH research. Recent findings Pregnancy-related complications, but not losses, are increased in IIH, while symptom severity is not affected. Weight loss of 24% results in normalization of intracranial pressure (ICP) and improvement in papilledema. Prolonged periods of papilledema results in delayed thinning of the ganglion cell layer. Less-invasive telemetry has improved understanding of the positional effects on ICP with rises seen in the supine and lateral decubitus. Exenatide, a GLP-1 agonist, may reduce ICP and improve symptoms. Venous sinus stenting is increasingly popular but its benefits over CSF diversion remains unclear. Summary Early involvement of obstetric care is recommended with pregnancy in IIH. Early intervention is required to avoid chronic papilledema that confers worse visual outcomes. Positional changes may affect ICP readings. The use of novel ICP telemetric devices has significant potential in future disease monitoring. The dual benefits of weight loss and ICP reduction with exenatide have significant potential in IIH management. Surgical RCTs are still required.

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A-Scan Ultrasonographic Evaluation of Patients with Idiopathic Intracranial Hypertension: Comparison of Optic Nerves

Cited by 25 publications

References 30 publications

Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure

Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure

A Novel Method for Prediction of Raised Intracranial Pressure Through Automated ONSD and ETD Ratio Measurement From Ocular Ultrasound

Idiopathic intracranial hypertension: expanding our understanding

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