Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death

Topçuoğlu, Mehmet Akif; Arsava, Ethem Murat; Baş, Demet Funda; Kozak, Hasan Hüseyin

doi:10.1111/jon.12233

Cited by 38 publications

(31 citation statements)

References 11 publications

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“…The ONSD was identified by measuring the distance between the external borders of the hyperechogenic area surrounding the optic nerve, corresponding to the periorbital subarachnoid space (Fig ) . Because a different method for the ONSD evaluation is described in the literature (that includes the external hypoechogenic borders of the ONSD—the so‐called ONSD E , corresponding to dura mater and periorbital fat), for descriptive and comparative scopes we also measured this diameter . Once recognized, three measurements (taken 3 mm behind the globe) of the ONSD on the transverse plane were recorded for each eye.…”

Section: Methodsmentioning

confidence: 99%

“…16 Because a different method for the ONSD evaluation is described in the literature (that includes the external hypoechogenic borders of the ONSD-the so-called ONSD E , corresponding to dura mater and periorbital fat), for descriptive and comparative scopes we also measured this diameter. 17 Once recognized, three measurements (taken 3 mm behind the globe) of the ONSD on the transverse plane were recorded for each eye. By averaging these values, the binocular median ONSD values were obtained for each eye.…”

Section: Transorbital Sonographymentioning

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: Methodsmentioning

confidence: 99%

Section: Transorbital Sonographymentioning

confidence: 99%

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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“…It is indeed pleonastic that BD diagnosis in ICU is not made upon the only evaluation of ONSD. In fact, even though ONSD is significantly greater in subjects with BD, quantification of ONSD cannot discriminate BD subjects from comatose ones with raised ICP with 100% certainty [25]. …”

Section: Discussionmentioning

confidence: 99%

Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring

Toscano

Spadetta

Pulitano

et al. 2017

BioMed Research International

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Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD). Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD. 31 nonneurological controls were used for standard ONSD reference. Results. Patients with neurological diseases, before BD, showed higher ONSD values than control group (CTRL: RT 0.45 ± 0.03 cm; LT 0.45 ± 0.02 cm; pre-BD: RT 0.54 ± 0.02 cm; LT 0.55 ± 0.02 cm; p < 0.000) even without intracranial hypertension, evaluated with invasive monitoring. ONSD was further significantly markedly increased in respect to the pre-BD evaluation in neurocritical patients after BD, with mean values above 0.7 cm (RT 0.7 ± 0.02 cm; LT 0.71 ± 0.02 cm; p < 0.000), with a corresponding dramatic raise in intracranial pressure. Logistic regression analysis showed a strong correlation between ONSD and ICP (R 0,895, p < 0.001). Conclusions. ONSD is a reliable marker of intracranial hypertension, easy to be performed with a minimal training. Routine ONSD daily monitoring could be of help in Intensive Care Units when invasive intracranial pressure monitoring is not available, to early recognize intracranial hypertension and to suspect BD in neurocritical patients.

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“…TCCS of the basal brain arteries is explicitly included in the Latin American, German, Dutch, Swiss, and Czech guidelines as a method for detecting cerebral circulatory arrest [1,12,17,20,22]. Dilation of the optical nerve sheath due to increased intracranial pressure can be detected using transorbital B-mode ultrasound but does not provide a reliable diagnosis of irreversible cessation of brain function and is therefore not suitable as an ancillary method for diagnosing brain death [23]. Therefore, it will not play a role in international brain death protocols in the future.…”

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confidence: 99%

Doppler and Duplex Sonography for the Diagnosis of the Irreversible Cessation of Brain Function (“Brain Death”): Current Guidelines in Germany and Neighboring Countries

2016

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Extra- and transcranial sonography of brain-supplying arteries is accepted worldwide in brain death protocols as a valid ?ancillary? method of proving brain circulatory arrest. Color-coded duplex sonography and CT angiography have been newly incorporated in the fourth update of the German Medical Association?s guidelines for the determination of the irreversible cessation of brain function (?brain death?), effective July 2015. The updated guidelines address in more detail the diagnostic procedures and the required qualifications of the examiners. The present article summarizes the guidelines and the recommendations regarding the application and documentation of ultrasound findings for the diagnosis of brain circulatory arrest in children and adults, as valid in Germany. The method, limitations, and procedure in the case of inconclusive findings are described. Age-related minimum values of mean arterial pressure for the diagnosis of cerebral circulatory arrest in children are presented. A concise overview of the respective regulations for the use of sonography for diagnosing brain death in other countries, especially in the countries neighboring Germany, is given.

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Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death

Abstract: ONSD is significantly greater in subjects with BD. However, quantification of ONSD cannot discriminate BD subjects from comatose ones with raised ICP with 100% certainty.

Cited by 38 publications

References 11 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

Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring

Doppler and Duplex Sonography for the Diagnosis of the Irreversible Cessation of Brain Function (“Brain Death”): Current Guidelines in Germany and Neighboring Countries

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