The role of optic nerve sheath diameter ultrasound in brain infection

Stead, Gavin; Cresswell, Fiona V; Jjunju, Samuel; Oanh, Pham Kieu Nguyet; Thwaites, Guy; Donovan, Joseph

doi:10.1016/j.ensci.2021.100330

Cited by 9 publications

(6 citation statements)

References 52 publications

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“…Reports have shown decreased mortality and decreased sequela in those monitored for ICP and treated promptly, particularly in severe cases. Further exploration into diverse modalities for monitoring ICP in patients with bacterial meningitis and elevated ICP is needed [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Changing Landscape of Haemophilus influenzae Meningitis and Implication on Public Health

Allonce,

Ahsan,

Browne

et al. 2024

Case Reports in Infectious Diseases

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Haemophilus influenzae (H. influenzae) has evolved as a prominent pathogen, with nontypeable strains (NTHi) emerging as a leading cause of invasive disease, particularly among the elderly. Since the introduction of Haemophilus influenzae B (Hib) vaccine, invasive infection has shifted from children with Hib to the elderly with NTHi. NTHi affects those primarily with predisposing factors such as an immunocompromised state, CSF leakage, or ENT infections. We present two cases that emphasize the shift of invasive infection, risk factors, and elevated intracranial pressure (ICP) as a complication. Case 1. A 75-year-old female with a sudden onset of weakness and respiratory symptoms deteriorated rapidly. Imaging revealed mastoid effusion and ventriculitis, likely originating from otomastoiditis. Lumber puncture confirmed NTHi. ICU course complicated by elevated ICP prompted repeat lumbar puncture. The patient recovered after 8 days but not near baseline. Case 2. A 50-year-old female with altered mental status, headache, and ear pain exhibited signs of pansinusitis and pseudotumor cerebri. Elevated ICP was evident upon lumbar puncture, and NTHi was isolated in CSF and blood cultures. MRI of the brain showed prominent optic nerve sheaths and transverse sinus arachnoid granulations’ concern for underlying pseudotumor cerebri. Repeat lumbar puncture or ventricular drainage was deferred after discussion with neurosurgery. Diabetes was identified as a comorbidity. The patient’s condition improved after 14 days of antibiotics and dexamethasone. These cases emphasize the shifting landscape of H. influenzae meningitis, primarily driven by NTHi, especially among the elderly. Although NTHi infections were considered less invasive, recent epidemiology review indicated it as the leading cause of H. influenzae meningitis. With the increasing prevalence of NTHi and its increase in invasive patterns, it is crucial to implement vaccination strategies and develop new vaccines targeting NTHi.

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Section: Discussionmentioning

confidence: 99%

Changing Landscape of Haemophilus influenzae Meningitis and Implication on Public Health

Allonce,

Ahsan,

Browne

et al. 2024

Case Reports in Infectious Diseases

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“…ONSD measurement using ultrasonography is a fast, inexpensive, non-invasive, and widely available imaging modality that may serve as a surrogate marker for elevated ICP. It has been used to detect increased ICP in meningitis, traumatic brain injury, and ischemic stroke [ 5 , 6 ]. Daily ONSD measurement in this patient with rabies encephalitis correlated temporally with CT and MRI findings of cerebral edema and acute SAH.…”

Section: Discussionmentioning

confidence: 99%

Rabies Encephalitis and the Use of Optic Nerve Sheath Diameter to Detect Elevated Intracranial Pressure

Kaufman¹,

Teng²,

Biro³

2022

Cureus

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Rabies is a rare but rapidly progressive and almost universally fatal disease. A previously healthy 59-yearold male presented with rabies encephalitis. We measured his optic nerve sheath diameter (ONSD) daily in both eyes using ultrasonography to indirectly monitor for elevated intracranial pressure (ICP). We performed CT and MRI brain on days when his ONSD changed significantly. An increase in ONSD temporally correlated with radiologic findings of cerebral edema and acute subarachnoid hemorrhage (SAH). ONSD measurement is a fast, inexpensive, and widely-available imaging modality that may serve as a surrogate marker for elevated ICP. It may be especially useful in patients who are difficult to be transported to radiology due to the unstable nature of their disease.

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“…Growing research into noninvasive monitors hold promise for the identification and management of elevated ICP in encephalitis [40]. Optical nerve sheath diameter ultrasound has been used as a proxy for ICP monitoring in brain infections [41] while pupillometry may assist with early detection of worsening edema [42]. Noninvasive monitors such as brain4care have developed noninvasive ICP waveform analysis device which may inform clinicians to impairment in intracranial compliance and can used continuously to evaluate treatment response [43].…”

Section: Multimodality Monitoringmentioning

confidence: 99%

Autoimmune and inflammatory neurological disorders in the intensive care unit

Legouy,

Cervantes,

Sonneville

et al. 2024

Current Opinion in Critical Care

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Purpose of review The present review summarizes the diagnostic approach to autoimmune encephalitis (AE) in the intensive care unit (ICU) and provides practical guidance on therapeutic management. Recent findings Autoimmune encephalitis represents a group of immune-mediated brain diseases associated with antibodies that are pathogenic against central nervous system proteins. Recent findings suggests that the diagnosis of AE requires a multidisciplinary approach including appropriate recognition of common clinical syndromes, brain imaging and electroencephalography to confirm focal pathology, and cerebrospinal fluid and serum tests to rule out common brain infections, and to detect autoantibodies. ICU admission may be necessary at AE onset because of altered mental status, refractory seizures, and/or dysautonomia. Early management in ICU includes prompt initiation of immunotherapy, detection and treatment of seizures, and supportive care with neuromonitoring. In parallel, screening for neoplasm should be systematically performed. Despite severe presentation, epidemiological studies suggest that functional recovery is likely under appropriate therapy, even after prolonged ICU stays. Conclusion AE and related disorders are increasingly recognized in the ICU population. Critical care physicians should be aware of these conditions and consider them early in the differential diagnosis of patients presenting with unexplained encephalopathy. A multidisciplinary approach is mandatory for diagnosis, ICU management, specific therapy, and prognostication.

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The role of optic nerve sheath diameter ultrasound in brain infection

Cited by 9 publications

References 52 publications

Changing Landscape of Haemophilus influenzae Meningitis and Implication on Public Health

Changing Landscape of Haemophilus influenzae Meningitis and Implication on Public Health

Rabies Encephalitis and the Use of Optic Nerve Sheath Diameter to Detect Elevated Intracranial Pressure

Autoimmune and inflammatory neurological disorders in the intensive care unit

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