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

Abstract

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.

Intra and Interobserver Variability in the B-mode Transorbital Sonographic Measurement of the Optic Nerve Sheath Diameter in Healthy Nepalese Individuals

“…Intracranial hypertension is a life-threatening condition with significant morbidity and mortality. 4 A myriad of neurological as well as non-neurological conditions can lead to elevated intracranial pressure (ICP). An early recognition of the entity is warranted for management of such conditions.…”

Salmonella typhi Meningitis in an Immunocompetent Asian Adult

“…Salmonella meningitis is frequently complicated with intracranial abscesses [15], cerebral edema [16], and hydrocephalous as in our patient. Mahapatra et al described a case series of six pediatric patients with sudural empyema requiring drainage [18].…”

“…Therefore, noninvasive bedside ultrasonography has emerged as an attractive alternative to diagnose and monitor ICH. Ultrasonography of optic nerve sheath diameter (ONSD) shows a good level of diagnostic accuracy for detecting intracranial hypertension [14-15].…”

The Concordance of Optic Nerve Sheath Diameter Measurements with the Clinical Course in Children with Traumatic Head Injury

“…There are many studies in the literature showing that ONSD increases with the increased ICP in patients with TBI. [13,15] Control brain CT can also be performed if there is a clinical worsening or change during follow-up of patients with TBI, or in the follow-up of patients. In the present study, ONSD values on the control brain CTs have been examined and the relationship between impaired clinical status and ICP increase has been investigated.…”