Optic Nerve Ultrasound for the Detection of Raised Intracranial Pressure

Rajajee, Venkatakrishna; Vanaman, Monique; Fletcher, Jeffrey J.; Jacobs, Teresa L.

doi:10.1007/s12028-011-9606-8

Cited by 384 publications

(347 citation statements)

References 22 publications

(40 reference statements)

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“…4 Previous studies have shown high levels of correlation between optic nerve sheath width by ultrasonography and intracranial pressure measured directly through invasive monitors. [11][12][13] A study by Neudorfer et al 14 showed that increased optic nerve sheath width by orbital ultrasonography correlated well with the final diagnosis of papilledema or pseudopapilledema in a pediatric population. Our study aims to further evaluate the role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in a cohort of adult patients who were referred to the neuroophthalmology service for the evaluation of swollen optic nerves.…”

Section: Introductionmentioning

confidence: 99%

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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Purpose To determine the sensitivity and specificity of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in adult patients. Methods The records of all adult patients referred to the neuro-ophthalmology service who underwent orbital ultrasonography for the evaluation of suspected papilledema were reviewed. The details of history, ophthalmologic examination, and results of ancillary testing including orbital ultrasonography, MRI, and lumbar puncture were recorded. Results of orbital ultrasonography were correlated with the final diagnosis of papilledema or pseudopapilledema on the basis of the clinical impression of the neuro-ophthalmologist. Ultrasound was considered positive when the optic nerve sheath diameter was Z3.3 mm along with a positive 301 test. Results The sensitivity of orbital ultrasonography for detection of papilledema was 90% (CI: 80.2-99.3%) and the specificity in detecting pseudopapilledema was 79% (CI: 67.7-90.7%). Conclusions Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive, but less specific in differentiating papilledema from pseudopapilledema in adult patients, and can be useful in guiding further management of patients in whom the diagnosis is initially uncertain.

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Section: Introductionmentioning

confidence: 99%

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Carter

Pistilli

Livingston

et al. 2014

Eye

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“…11, 25 Rajajee et al 25 conducted a comparison between ONSD and I-ICP measurements, EVD, and intraparenchymal monitoring, indicating that the optimal ONSD for detection of ICP ≥ 20 mm Hg was ≥ 0.48 cm (sensitivity 96% and specificity 94%). Spearman's correlation coefficient of an ONSD of 0.52 cm for detection of ICP ≥ 20 mm Hg was 0.73.…”

Section: Discussionmentioning

confidence: 99%

“…Spearman's correlation coefficient of an ONSD of 0.52 cm for detection of ICP ≥ 20 mm Hg was 0.73. 25 The main limitation of this method is that the measurement accuracy corresponds to the operator's experience and equipment, as well as the fact that the ONSD criterion (i.e., cutoff for ICP hypertension) is not well established. 13,25 All of the aforementioned drawbacks can be counterproductive to the implementation of this method and its effectiveness in ICUs.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a novel noninvasive ICP monitoring device in patients undergoing invasive ICP monitoring: preliminary results

Ganslandt

Mourtzoukos

Stadlbauer

et al. 2018

Journal of Neurosurgery

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ABBREVIATIONS AUC = area under the curve; CPP = cerebral perfusion pressure; EVD = external ventricular drainage; I-ICP = invasive intracranial pressure; ICU = intensive care unit; IPM = intraparenchymal monitor; NI-ICP = noninvasive ICP; ONSD = optic nerve sheath diameter; ROC = receiver operating characteristic; TBI = traumatic brain injury. In this study a new method of NI-ICP monitoring performed using algorithms to determine ICP based on acoustic properties of the brain was applied in patients undergoing invasive ICP (I-ICP) monitoring, and the results were analyzed. METHODS In patients with traumatic brain injury and subarachnoid hemorrhage who were undergoing treatment in a neurocritical intensive care unit, the authors recorded ICP using the gold standard method of invasive external ventricular drainage or intraparenchymal monitoring. In addition, the authors simultaneously measured the ICP noninvasively with a device (the HS-1000) that uses advanced signal analysis algorithms for acoustic signals propagating through the cranium. To assess the accuracy of the NI-ICP method, data obtained using both I-ICP and NI-ICP monitoring methods were analyzed with MATLAB to determine the statistical significance of the differences between the ICP measurements obtained using NI-ICP and I-ICP monitoring. RESULTS Data were collected in 14 patients, yielding 2543 data points of continuous parallel ICP values in recordings obtained from I-ICP and NI-ICP. Each of the 2 methods yielded the same number of data points. For measurements at the ≥ 17-mm Hg cutoff, which was arbitrarily chosen for this preliminary analysis, the sensitivity and specificity for the NI-ICP monitoring were found to be 0.7541 and 0.8887, respectively. Linear regression analysis indicated that there was a strong positive relationship between the measurements. Differential pressure between NI-ICP and I-ICP was within ± 3 mm Hg in 63% of data-paired readings and within ± 5 mm Hg in 85% of data-paired readings. The receiver operating characteristic-area under the curve analysis revealed that the area under the curve was 0.895, corresponding to the overall performance of NI-ICP monitoring in comparison with I-ICP monitoring. CONCLUSIONS This study provides the first clinical data on the accuracy of the HS-1000 NI-ICP monitor, which uses advanced signal analysis algorithms to evaluate properties of acoustic signals traveling through the brain in patients undergoing I-ICP monitoring. There is growing evidence that ICP monitoring and protocol-driven therapy help to improve clinical outcome in a number of pathologies such as traumatic brain injury (TBI), brain infections such as meningitis, and brain tumors. 22 To date, ICP monitoring is still an invasive procedure in which a burr hole is used to introduce a transducer-coupled probe into the brain parenchyma or into the ventricles. Invasive ICP ©AANS, 2017 SUBMITTED

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“…KİB yüksekliğini işaret eden eşik değer çeşitli yayınlarda 4,8-5,8 mm arasında gösterilmekle birlikte (43)(44)(45)(46) bir konsensusdan söz etmek mümkün değildir. Optimal değer olarak 5 mm'nin kabul edilmesi yerindedir.…”

Section: Orta-hat şIftinin Sonografik öLçümüunclassified

Neurosonology of intracranial pressure increase

Togcuoglu¹,

Arsava²

2011

Türk Beyin Damar Hast Derg

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Nörolojik yoğun bakımlarda kafa içi basıncı yükselmesi sadece sık görülmesinden dolayı değil aynı zamanda tedavi edilebilir olmasından dolayı da önemli bir problemdir. Birçok hastalığın seyrinde kafa içi basıncının doğrudan ölçümü ya da tahmin edilmesinin kritik önemi vardır. Non-invazif ve yatak başında kullanılabilen birçok nörosonolojik yöntem ile kafa içi basıncı monitörize edilebilir. Bu makalede bu yöntemler literatür bilgisi ışığında pratik uygulama temel alınarak gözden geçirilmektedir. Anahtar Sözcükler: Transkranial Doppler, B-mod, pulsatilite, orta hat şifti, orbital sonografi, otoregülasyon. NEUROSONOLOGY OF INTRACRANIAL PRESSURE INCREASE SUMMARYIncrease in intracranial pressure (ICP) is one of the most significant problems in the neurological intensive care units not only due to its high prevalence, but also due to its treatable nature. Direct measurement or indirect estimation of ICP during the course of many neurological diseases is of critical importance. A variety of neurosonogical methodologies, which are totally non invasive and applicable at the bed-side repeatedly, have extensively been used to evaluate and monitor ICP. These neurosonological techniques, including most recent developments, are herein reviewed primarily from the perspective of practical applications.

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Optic Nerve Ultrasound for the Detection of Raised Intracranial Pressure

Abstract: Bedside ONSD measurement, performed by neurointensivists, is an accurate, non-invasive method to identify ICP > 20 mmHg in a heterogeneous group of patients with acute brain injury. ONSD ≥0.48 cm has the greatest accuracy, however, internal validation of ONSD criteria may be required.

Cited by 384 publications

References 22 publications

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema

Evaluation of a novel noninvasive ICP monitoring device in patients undergoing invasive ICP monitoring: preliminary results

Neurosonology of intracranial pressure increase

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