Accuracy of crescent sign on ocular ultrasound in diagnosing papilledema

Bhosale, Ananth; Shah, Virna M; Shah, Parag K

doi:10.5662/wjm.v7.i3.108

Cited by 14 publications

(13 citation statements)

References 9 publications

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“…We noticed that all the patients with a positive crescent sign were having elevated ICP measuring (≥300 mmHg). In a recent study in India which was carried out by Bhosale et al in 2017,[20] and in another one in 2011 by Neudorfer et al ,[21] it was found that the sensitivity was higher, (92%) and (90%), respectively, but they did not count the specificity because all the patients in their studies were proved to have raised ICP.…”

Section: Discussionmentioning

confidence: 99%

Role of orbital ultrasound in the assessment of clinically detected papilledema

Mohson

Auday

2019

J Med Ultrasound

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Background:Increased intracranial pressure (ICP) is frequently seen, and it is considered a serious problem that needs a careful assessment and management, especially by easy and least invasive modalities.Objective:The objective of the study is to assess the optic nerve sheath diameter (ONSD) using transorbital ultrasound (US) as a marker and indicator for diagnosing raised intracranial pressure.Patients and Methods:It is a prospective study that was carried out in Neurology and/or Ophthalmology Clinics, Baghdad Teaching Hospital in the Medical City Complex during the period from June 2016 to May 2017; in this study, 40 patients seeking medical help for other causes were considered to be a control group and the other 40 patients who were complaining of raised ICP symptoms and suggested of having optic disc swelling by ophthalmoscopy examination. All the patients and the control group were examined by transorbital US to measure the ONSD, and then, only the patients with symptoms of raised intracranial underwent a lumbar puncture (LP).Results:Pearson's correlation test was used, demonstrating a very significant correlation between the ultrasonographic ONSD and the measurements of LP (R > 0.9) and (P < 0.001). Transorbital US yielded high sensitivity (91.6%) with modest specificity (75%) and high accuracy (90.0%) of ONSD was considered the normal the cutoff value of (5 mm) obtained from the control group. The US also showed the crescent sign and the optic disc bulging with lower sensitivity than the ONSD (61.1% and 41.6%, respectively) but with very high specificity (100%) for both.Conclusion:ONSD by transorbital ultrasonography is highly accurate, easily performed, and noninvasive procedure for the detection of raised ICP. Routine daily monitoring of ONSD could be of help in intensive care units when invasive ICP monitoring is not available or contraindicated; it also has a good role in early recognition of intracranial hypertension.

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Section: Discussionmentioning

confidence: 99%

Role of orbital ultrasound in the assessment of clinically detected papilledema

Mohson

Auday

2019

J Med Ultrasound

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“…If this diameter is noted to be increased in primary gaze and diminishes by 25% in eccentric gaze (30° test), then increased subarachnoid fluid surrounding the optic nerve is presumed to be present and this finding is consistent with papilledema. [22] Presence of fluid around the optic nerve as a “crescent” or “doughnut” sign has been shown to be useful in confirming papilledema. [22]…”

Section: Discussionmentioning

confidence: 99%

“…[22] Presence of fluid around the optic nerve as a “crescent” or “doughnut” sign has been shown to be useful in confirming papilledema. [22]…”

Section: Discussionmentioning

confidence: 99%

Role of ultrasonographic optic nerve sheath diameter in the diagnosis and follow-up of papilledema and its correlation with Frisén's severity grading

Raghunandan

Joseph

Nithyanandam

et al. 2019

Indian J Ophthalmol

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Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t -test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] ( P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema ( P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.

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“…[ 2 3 ] Alternatively, USG measurement of ONSD is also quite sensitive and specific for IH. [ 7 8 9 ] The choice of newer radiological modalities depends upon the availability of radiological investigations at hand. While USG is quick, its interpretation may vary from person to person, and even the same operator may have variation in the estimation of ONSD upon repeated attempts.…”

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confidence: 99%

“…[ 10 ] Acute and chronic IH may be differentiated with the help of the crescent sign on USG (seen in papilledema), which indicates chronicity. [ 8 ]…”

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confidence: 99%