The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure

Tarzamni, Mohammad Kazem; Derakhshan, Babak; Meshkini, Ali; Merat, Hamid; Fouladi, Daniel Fadaei; Mostafazadeh, Samira; Rezakhah, Amir

doi:10.1016/j.clineuro.2015.12.007

Cited by 17 publications

(21 citation statements)

References 46 publications

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“…Our findings confirmed this assumption, but results are still limited because of inferiority if compared to the accuracy of ONSD measurements. These results agree with those achieved by Tarzamni, suggesting that the study of the orbital vessels appears to be not accurate enough for the evaluation of ICP because many factors, including arterial pressure, diseases affecting the small vessels, age of patients, local autoregulation, cerebral perfusion pressure, and interindividual variability may influence the local flow …”

Section: Discussionsupporting

confidence: 86%

“…Previous studies showed a positive correlation between ONSD and hemorrhage volume or midline shift . In patients with ICH and elevated ICP, our work confirmed a good correlation between ONSD and hemorrhage volume at admission, but missed to find an association with midline shift.…”

Section: Discussionsupporting

confidence: 85%

“…Whether those techniques are promising, data on diagnostic accuracy are variable and no consensus has been reached . Recently, the diagnostic performance of Doppler indices of ophthalmic arteries has been compared to ONSD, resulting in a lower ability in the detection of elevated ICP . The central retinal artery and vein are accessible to ultrasound in their terminal portion through the transorbital window but they have never been studied for this purpose during acute raised ICP.…”

Section: Discussionmentioning

confidence: 99%

“…Considering their path, we speculated that ONSD enlargement during raised ICP could be transmitted into the intraaxial structures of the meningeal sheaths and, therefore, determine flow variations of Doppler parameters of retinal vessels. In this context, very few data are available concerning possible hemodynamic flow alterations of orbital vessels in conditions of elevated ICP, especially for central retinal artery and vein …”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Naldi

Pivetta

Coppo

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Evaluation of the diagnostic accuracy of optic nerve sheath diameter (ONSD) and Doppler indices of central retinal arteries and veins for the detection of increased intracranial pressure (ICP) in intracerebral hemorrhage (ICH) and of the usefulness of a second assessment of these variables in the monitoring of ICH. METHODS A total of 46 acute ICH patients with (group 1, n = 25) and without (group 2, n = 21) clinical and radiological computed tomography signs of raised ICP and 40 healthy controls were recruited. The median binocular ONSD and Doppler indices of retinal vessels including resistive index (RI) and retinal venous pulsation (RVP) were compared among groups, both at admission and later during ICH monitoring. RESULTS Median binocular ONSD showed higher accuracy for the detection of increased ICP (sensitivity and specificity 100%), while Doppler indices were less accurate (sensitivity 48% and specificity 95% for RI; 80% and 62% for RVP). In ICH patients, ONSD was significantly elevated in group 1 both at admission (6.40 mm [interquartile range [IQR] = .70] vs. 4.70 [.40]) and at control time (6.00 [.55] vs. 4.55 [.40]; P < .01), as well as RI (.79 [.11] vs. .77 [.03] and .80 [.06] vs. .75 [.35]; P = .01). RVP was significantly increased in group 1 only at admission (3.20 cm/s [1.05] vs. 2.00 [1.55], P = .02). CONCLUSIONS Median binocular ONSD evaluation showed higher accuracy for the estimation of elevated ICP compared with Doppler indices of retinal vessels. The ONSD enlargement detected in the early phase of ICH persists at control time.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Naldi

Pivetta

Coppo

et al. 2019

Journal of Neuroimaging

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“…). A total of 34 studies provided mean values for ONSD measurement . The pool of mean ONSD measurements was 4.78 mm (95% CI, 4.63‐4.94 mm; Fig.…”

Section: Resultsmentioning

confidence: 99%

Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis

Schroeder

Katsanos

Richter

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE To date, normal values for optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) for transorbital sonography (TOS) have only been reported by individual small‐scale studies, exposing a great variability in the measurement of the OND and ONSD. METHODS We performed a systematic review and metanalysis of available to date studies on TOS evaluation of adults without elevated intracranial pressure to provide an overview of the published literature, measuring methods and further specify normal values for OND and ONSD. RESULTS In total, we included 39 studies with 2,927 healthy volunteers (mean age 36.1 years, 44.4% female), so that a total of 5,854 eyes were examined. All pooled analyses were based on random effect models. Mean values for OND were provided in 13 studies. Calculated mean pooled OND value was 3.08 mm (95% confidence interval [CI], 2.9‐3.25), with low heterogeneity across studies (I2 = 12.7%). Thirty‐four studies provided mean values for ONSD measurement. The pool of mean ONSD measurements was 4.78 mm (95% CI, 4.63‐4.94), with evidence of substantial heterogeneity between estimates ONSD (I2 = 50.6%). There were no significant differences (P = .139) in the subsequent subgroup analysis for the different geographic continents. Also, no significant differences could be recorded for the effect of age (P = .824) or gender (P = .093). CONCLUSIONS TOS is a frequently described and widely used method. We provide reference values of OND and ONSD that are based on metanalytical analysis. Different measuring methods of ONSD result in higher heterogeneity. Subgroup analysis revealed no significant correlation between ONSD and age, gender, or geographic origin.

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Prediction of poor prognosis using the peak systolic velocity and early diastolic velocity of the central retinal artery in patients with post‐cardiac arrest syndrome

Choi,

Lee

2024

Hong Kong j. emerg. med.

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IntroductionMonitoring intracranial pressure (ICP) in patients with post‐cardiac arrest syndrome (PCAS) is crucial for effective management and prognosis assessment. However, continuous ICP monitoring is rarely practiced. Increased ICP is often associated with the impairment of brain autoregulation. This study investigated whether central retinal artery (CRA) flow velocity, autoregulation status according to mean arterial pressure (MAP), and the optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio could predict poor prognosis related to increased ICP in PCAS patients.MethodsIn this multicenter prospective observational study, transocular ultrasonography of the optic nerve sheath was performed on 38 PCAS patients treated with targeted temperature management from December 2021 to November 2022. CRA peak systolic velocity (PSV), early diastolic velocity (eDV), MAP, CRA‐PSV changes following MAP changes (autoregulation), and ONSD/ETD ratio were measured repeatedly from days 0 to 4 post‐admission.ResultsUnivariable analysis indicated that CRA‐PSV, nonpositive or flat CRA‐eDV, and disrupted autoregulation correlated with a poor prognosis (Cerebral Performance Category 4 or 5). In multivariable analysis, nonpositive CRA‐eDV or disrupted autoregulation was the most significant predictor of poor prognosis (odds ratio, 40.576; p = 0.002), with an area under the curve of 0.774. The ONSD/ETD ratio did not show a significant correlation.ConclusionsNonpositive CRA‐eDV, CRA‐PSV and disrupted autoregulation can predict poor prognosis in PCAS patients. Transocular Doppler ultrasonography of the CRA and autoregulation assessment may aid in ICP monitoring and management in PCAS patients.

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The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure

Cited by 17 publications

References 46 publications

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis

Prediction of poor prognosis using the peak systolic velocity and early diastolic velocity of the central retinal artery in patients with post‐cardiac arrest syndrome

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