Role of orbital ultrasound in the assessment of clinically detected papilledema

Abstract

Background:Increased intracranial pressure (ICP) is frequently seen, and it is considered a serious problem that needs a careful assessment and management, especially by easy and least invasive modalities.Objective:The objective of the study is to assess the optic nerve sheath diameter (ONSD) using transorbital ultrasound (US) as a marker and indicator for diagnosing raised intracranial pressure.Patients and Methods:It is a prospective study that was carried out in Neurology and/or Ophthalmology Clinics, Baghdad Teaching Hospital in the Medical City Complex during the period from June 2016 to May 2017; in this study, 40 patients seeking medical help for other causes were considered to be a control group and the other 40 patients who were complaining of raised ICP symptoms and suggested of having optic disc swelling by ophthalmoscopy examination. All the patients and the control group were examined by transorbital US to measure the ONSD, and then, only the patients with symptoms of raised intracranial underwent a lumbar puncture (LP).Results:Pearson's correlation test was used, demonstrating a very significant correlation between the ultrasonographic ONSD and the measurements of LP (R > 0.9) and (P < 0.001). Transorbital US yielded high sensitivity (91.6%) with modest specificity (75%) and high accuracy (90.0%) of ONSD was considered the normal the cutoff value of (5 mm) obtained from the control group. The US also showed the crescent sign and the optic disc bulging with lower sensitivity than the ONSD (61.1% and 41.6%, respectively) but with very high specificity (100%) for both.Conclusion:ONSD by transorbital ultrasonography is highly accurate, easily performed, and noninvasive procedure for the detection of raised ICP. Routine daily monitoring of ONSD could be of help in intensive care units when invasive ICP monitoring is not available or contraindicated; it also has a good role in early recognition of intracranial hypertension.

Ultrasonic optic disc height combined with the optic nerve sheath diameter as a promising non-invasive marker of elevated intracranial pressure

“…A previous study found an elevated optic disc when using ultrasound to measure the ONSD to evaluate ICP and used the presence or absence of the optic disc as the basis for the diagnosis of elevated ICP. Although the specificity of the diagnosis was 100%, the sensitivity was only 41.6% (Mohson and Auday, 2019). In our study, ODH was specifically measured, and the sensitivity and specificity were 73% and 83%, respectively.…”

“…A growing body of research has begun to identify more markers that may assist in the assessment of high intracranial pressure and thus improve the accuracy of the assessment of high intracranial pressure. In addition to measuring the ONSD and identifying the optic disc bulge, ocular ultrasound has indicated a further marker, the crescent sign, which is less sensitive but has high specificity (100%) (Mohson and Auday, 2019). A recent study showed that the deformability index (DI) is a dynamic parameter that quantifies the pulsatile nature of optic nerve sheaths and can distinguish between patients with elevated and normal ICP.…”

Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis

“… Komut 2016 [ 21 ] Turkey Prospective 50 5.4 Toshiba Aplio 500 Platinum ED CT Mixed 3 mm proximal to the optic disc; in transverse and sagittal planes. Mohson 2019 [ 22 ] Iraq Prospective 40 5.6558 Philips HD11XE Clinic LP Mixed 3 mm posterior to the globe; transverse. Moretti 2009 [ 23 ] Italy Prospective 19 6.2 Hitachi EUB 405 ICU Inv Trauma 3 mm behind the globe; one sagittal and one transverse.…”

Transorbital Ultrasonography Used to Detect Papilledema, in a Patient With Intracranial Hypertension

“…9 In the study of Teismann et al, 10 an optic disc elevation greater than 1.0 mm predicted optic disc edema, with a sensitivity of 73% and a specificity of 100%. Mohson et al 11 showed that the presence of optic disc bulging, without measuring its elevation, has a sensitivity of 61.1% and specificity of 100% for the detection of IH. It is important to take into account that the presence of papilledema may be due to other causes such as inflammatory diseases, infection, infiltrative conditions, and microvascular infarction.…”