Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients

Tayal, Vivek S.; Neulander, Matthew; Norton, H. James; Foster, Troy; Saunders, Timothy G.; Blaivas, Michael

doi:10.1016/j.annemergmed.2006.06.040

Cited by 420 publications

(355 citation statements)

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“…Because the retrobulbar optic nerve is encased within a dural sheath containing cerebrospinal fluid (CSF) that is in communication with the rest of the central nervous system, dilation of the optic nerve sheath diameter has been proposed as a marker for elevated ICP. [6][7][8][9] In theory, then, a patient with chronically elevated ICP should exhibit both optic disc edema and a dilated, CSF-filled, retrobulbar optic nerve sheath. As noted above, however, a patient with acutely elevated ICP would be expected to have normal optic discs but a widened optic nerve sheath diameter.…”

Section: Discussionmentioning

confidence: 99%

“…3 EP-performed POC US has already been shown to be a useful tool in the evaluation of other ocular pathology such as retinal detachment, vitreous hemorrhage, and lens dislocation, 4,5 and multiple studies have attempted to correlate sonographic evaluation of the retrobulbar optic nerve sheath with ICP measurements. [6][7][8][9] Because sonography is routinely available in the emergency department (ED) for other indications and can be performed quickly even in cases where traditional fundoscopy is difficult or impossible, this technique may be of significant value in the evaluation of patients at risk for conditions associated with optic disc swelling.…”

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confidence: 99%

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Point-of-care Ocular Ultrasound to Detect Optic Disc Swelling

et al. 2013

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Objectives: Emergency physicians (EPs) frequently evaluate patients at risk for diseases that cause optic disc swelling, and they may encounter conditions that make traditional fundoscopy difficult or impossible. The objective was to assess whether EP-performed point-of-care (POC) ultrasound (US) could accurately assess swelling of the optic disc.Methods: This was a blinded, prospective study using a convenience sample of patients presenting to a neuroophthalmology clinic who were thought to be at risk for conditions associated with optic disc edema. Two EPs performed POC US examinations. Patients then underwent standard clinical assessment by a specialist.Results: Fourteen patients were assessed with disc swelling noted on dilated fundoscopic exam in 11 of 28 (39%) eyes. A maximum disc height greater than 0.6 mm as measured by US predicted the presence of optic disc edema noted on fundoscopic exam, with a sensitivity of 82% (95% confidence interval [CI] = 48% to 98%) and a specificity of 76% (95% CI = 50% to 93%). A threshold value of 1.0 mm for disc height yielded a sensitivity of 73% (95% CI = 39% to 94%) and a specificity of 100% (95% CI = 81% to 100%). Measurements of disc height as determined by optical coherence tomography (OCT) exhibited good correlation when compared to US measurements (r = 0.836, p < 0.0001, 95% CI = 0.65 to 0.93).Conclusions: These data suggest that EP-performed POC US can detect clinically apparent optic disc swelling. Because sonography can be performed readily at the bedside, even in cases where fundoscopy is difficult or impossible, this technique may prove to be a valuable tool for the assessment of optic disc swelling in the emergency department (ED).ACADEMIC EMERGENCY MEDICINE 2013; 20:920-925

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Point-of-care Ocular Ultrasound to Detect Optic Disc Swelling

et al. 2013

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“…Ultrasound-based ONSD measurements have been extensively used to quickly and non-invasively assess ICP both at clinical and research levels. From medical emergency screening for changes in ICP in intracranial hemorrhages [7] to clinical research in ICP variations to mountain climbing [8], a vast literature now exists validating the use of this method [5,6]. Nevertheless, and to the best of our knowledge, no study has yet used ultrasound measurements of ONSD to investigate ICP significance in glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Pinto

Vandewalle

Pronk

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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Purpose 1. Identify differences in optic nerve sheath diameter (ONSD) as an indirect measure of intracranial pressure (ICP) in glaucoma patients and a healthy population. 2. Identify variables that may correlate with ONSD in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. Methods Patients with NTG (n046) and POAG (n061), and healthy controls (n042) underwent B-scan ultrasound measurement of ONSD by an observer masked to the patient diagnosis. Intraocular pressure (IOP) was measured in all groups, with additional central corneal thickness (CCT) and visual field defect measurements in glaucomatous patients. Only one eye per patient was selected. Kruskal-Wallis or Mann-Whitney were used to compare the different variables between the diagnostic groups. Spearman correlations were used to explore relationships among these variables. Results ONSD was not significantly different between healthy, NTG and POAG patients (6.09±0.78, 6.03±0.69, and 5.71±0.83 respectively; p00.08). Visual field damage and CCT were not correlated with ONSD in either of the glaucoma groups (POAG, p00.31 and 0.44; NTG, p00.48 and 0.90 respectively). However, ONSD did correlate with IOP in NTG patients (r00.53, p<0.001), while it did not in POAG patients and healthy controls (p00.86, p00.46 respectively). Patient's age did not relate to ONSD in any of the groups (p>0.25 in all groups). Conclusions Indirect measurements of ICP by ultrasound assessment of the ONSD may provide further insights into the retrolaminar pressure component in glaucoma. The correlation of ONSD with IOP solely in NTG patients suggests that the translaminar pressure gradient may be of particular importance in this type of glaucoma.

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“…9,14,17 All previous studies on the relationship between ICP and optic nerve sheath diameter (ONSD) were performed crosssectionally. [9][10][11][12][13][14][15][16][17][18][19] ONSD distension was correlated to the ICP measured at the same moment. However, it remains unclear whether these changes in ONSD resulted only from ICP changes or from papilledema as well.…”

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confidence: 99%

Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure

Maissan¹,

Dirven²,

Haitsma³

et al. 2015

JNS

170

142

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E lEvatEd intracranial pressure (ICP) > 20 mm Hg is associated with poor outcome after traumatic brain injury (TBI). 2,13 Especially in the early posttraumatic period, elevated ICP is associated with a high risk of secondary ischemic brain damage. Interventions that lower the ICP should be started as soon as possible to optimize cerebral perfusion pressure and save brain tissue.3 Early diagnosis of elevated ICP is therefore essential in preventing this secondary damage. Elevated ICP and disorders noted on emergency CT scanning of the brain have a poor correlation.12 Invasive ICP measurement with an intraparenchymal probe is considered to be the gold standard.For safe insertion of the probe, optimal blood coagulation, sterile conditions, and a neurosurgeon are required.6 These are not readily available at the trauma scene. Therefore, a noninvasive, simple bedside method can be beneficial in early detection of increased ICP, especially in the prehospital and emergency care setting.Transcranial Doppler (TCD) pulsatility index and transocular ultrasonography have been suggested for rapid assessment of elevated ICP. The TCD pulsatility index detects decreases in cerebral perfusion pressure due to an increased ICP. 8 However, TCD is difficult to perform, even when the user is experienced. obJect Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD. Therefore, the authors researched whether ONSD and ICP simultaneously change during tracheal manipulation in patients in the intensive care unit (ICU) who have suffered a traumatic brain injury (TBI). materials The authors included 18 ICP-monitored patients who had sustained TBI and were admitted to the ICU. They examined the optic nerve sheath by performing ultrasound before, during, and after tracheal manipulation, which is known to increase ICP. The correlation between ONSD and ICP measurements was determined, and the diagnostic performance of ONSD measurement was tested using receiver operating characteristic curve analysis. results In all patients ICP increased above 20 mm Hg during manipulation of the trachea, and this increase was directly associated with a dilation of the ONSD of > 5.0 mm. After tracheal manipulation stopped, ICP as well as ONSD decreased immediately to baseline levels. The correlation between ICP and ONSD was high (R 2 = 0.80); at a cutoff of ≥ 5.0 mm ONSD, a sensitivity of 94%, a specificity of 98%, and an area under the curve of 0.99 (95% CI 0.97-1.00) for detecting elevated ICP were determined. coNclusioNs In patients who have sustained a TBI, ultrasonography of the ONSD is an accurate, simple, and rapid measurement for detecting elevated ICP as well as immediate changes in ICP. Therefore, it might be a useful tool to monitor ICP, especially in conditions in which invasive ICP monitoring is not available, such as at trauma scenes.

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Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients

Cited by 420 publications

References 11 publications

Point-of-care Ocular Ultrasound to Detect Optic Disc Swelling

Point-of-care Ocular Ultrasound to Detect Optic Disc Swelling

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure

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