Bedside ultrasound as a simple non-invasive method of assessing intracranial pressure in a limited resource setting

Zewdie, Ayalew; Tesema, Haymanot; Aklilu, Abenezer Tirsit; Teklemariam, Tsegazeab Laeke; Zewdu, Tigist; Ashagre, Yordanos; Bizuneh, Yemsrach; Azazh, Aklilu; Hassen, Getaw Worku

doi:10.1016/j.afjem.2016.06.002

Cited by 3 publications

(1 citation statement)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, CT and MRI are not always indicated, especially in critically ill patients who require high levels of inotropic support or ventilator support. The use of bedside US has shown to be an equivalent if not improved means of measuring elevated ICP via assessment of the ONSD [2]. The aim of this study was to investigate the usefulness of using bedside US to measure OSND to determine if a patient has elevated ICP.…”

Section: Introductionmentioning

confidence: 99%

Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound

Munawar

Khan

Hussain

et al. 2019

Cureus

View full text Add to dashboard Cite

Background The early detection of elevated intracranial pressure (ICP) can not only prevent mortality but also aid in more aggressive management. Brain computed tomography (CT) is a mainstay modality in detecting elevated ICP, but the feasibility of using brain CTs to detect elevated ICP in critically ill patients is limited, especially for patients who require high levels of inotropic support. The optic nerve sheath is a direct extension of the brain meninges. Therefore, the elevation of ICP is directly transmitted to the sheath. Measuring the optic nerve sheath diameter (ONSD) through ultrasound (US) is a bedside, noninvasive means to detect elevated ICP. The goal of this study was to assess the correlation of ONSD with elevated ICP as measured via US in an intensive care unit (ICU). Methods We conducted a six-month prospective, single-center, observational study of mass effect stroke patients aged 18 to 65 years who had a traumatic brain injury (TBI) and were admitted to the ICU. Patients with chronic hydrocephalus, extensive local orbit trauma, a pre-existing ocular disease affecting the optic nerve and/or orbital cavity, hyperthyroidism with exophthalmos, and facial trauma affecting the orbits and/or eyeballs were excluded. We measured the ONSD at the entry of optic nerve into the globe using two-dimensional (2D) US. Results One hundred patients were included in the study. Forty-nine patients had diffuse cerebral edema detected on CT scan correlating with increased ONSD notable via bedside US. The mean ONSD related to CT-detectable elevated ICP was 0.61 cm. The sensitivity for the ONSD cut-off value of ≥5.8 mm was 94% (95% confidence interval [CI], 84.05% to 98.79%), and the specificity was 96.08% (95% CI, 86.7% to 99.52%).The positive predictive value was 92.08% (95% CI, 86.28% to 98.96%), and the negative predictive value was 94.23% (95% CI, 84.47% to 98.00%). Conclusion The greatest accuracy in ONSD was found with a cut-off of >0.58 cm in patients with positive CT brain findings. Therefore, US can be used as an initial screening test when physicians suspect a patient has elevated ICP.

show abstract

Section: Introductionmentioning

confidence: 99%