Optic nerve sheath diameter ultrasonography for elevated intracranial pressure detection

Abstract

Ultrasonographically measured optic nerve sheath diameter measurement has become a common noninvasive approach for detecting elevated intracranial pressure. We present a case of aneurysmal subarachnoid hemorrhage with elevated intracranial pressure. Postoperative arachnoiditis developed, and lumbar puncture revealed low intracranial pressure. However, ultrasonography revealed a dilated optic nerve sheath, denoting elevated intracranial pressure. This was confirmed by computed tomography showing ventricular dilation. Ophthalmoscopy revealed papilledema and hemorrhage. This case study demonstrated that noninvasive bedside ultrasonographic optic nerve sheath diameter measurement can detect elevated intracranial pressure more accurately than lumbar puncture, especially in cases with intracranial infection.

Reply to: Ocular ultrasonography to detect intracranial pressure in aneurysmal subarachnoid hemorrhage

“…We would like to thank De Bernardo et al for their concern and thoughtful suggestions to our article 1,2 . We agree that ultrasound measurement of optic nerve sheath diameter (ONSD) for the evaluation of intracranial pressure (ICP) was mentioned earlier.…”

Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

“…These threshold values provide a qualitative indication of increased ICP. However, some studies have used ultrasonographic ONSD to quantitatively (mathematical formula) assess ICP values [71,72] (Eq. 53.7).…”

Ocular ultrasonography to detect intracranial pressure in aneurysmal subarachnoid hemorrhage

“…We congratulate Wang and colleagues for their interesting paper concerning the ultrasound evaluation of the optic nerve sheath diameter (ONSD) in a young patient with an aneurysmal subarachnoid hemorrhage and spinal arachnoiditis 1 …”

“…In the “Introduction” section, the authors stated that the possibility to assess the increase in intracranial pressure (ICP), measuring ONSD, was discovered in 1989 1 …”

“…The authors correctly stated that papilledema and hemorrhages could not only indicate increased ICP but also optic nerve inflammation or optic nerve compartment syndrome 1 . Standardized A‐scan is a very useful tool to resolve this doubt.…”