Comparing ultrasonographic optic nerve sheath diameter to head computed tomography scan to predict intracranial pressure elevation

Abstract

Introduction: Intracranial hypertension is an emergency condition that needs to be recognized as soon as possible. Lumbar puncture, the gold standard diagnostic procedure for intracranial hypertension, is contraindicated in some conditions while brain imaging procedures may be too difficult to be performed on critically ill patients. To solve this problem, this study aims to assess an alternative method to detect intracranial hypertension by measuring optic nerve sheath diameter using ocular ultrasound and optic nerve sheath diameter difference in each etiology. Methods: This cross-sectional study was conducted at the Emergency Department of Dr Iskak Tulungagung General Hospital. Sixty-nine patients who visited the emergency room for the first onset of intracranial pathology were included for optic nerve sheath diameter measurement by ultrasound. Subjects were divided into elevated and non-elevated intracranial pressure groups based on head computed tomography scan findings. The optic nerve sheath diameter results were compared and analyzed. Result: There were 29 subjects in the elevated intracranial pressure group and 40 subjects in the non-elevated intracranial pressure group. The mean of optic nerve sheath diameter in the elevated and non-elevated intracranial pressure groups was 0.63 ± 0.06 and 0.57 ± 0.06 cm, respectively ( p = 0.000). Based on receiver operating characteristics analysis, 0.58 cm was the most optimal cut-off value. Conclusion: Ultrasonographic optic nerve sheath diameter can be used to predict elevated intracranial pressure in suspected patients who are contraindicated to invasive intracranial pressure measurement or critically ill. There were significant differences between elevated and non-elevated intracranial pressure groups in stroke and trauma subjects.

Comparative study between ultrasound guided coronal versus axial optic nerve sheath diameter measurement in patients at risk of increased intracranial pressure

“…Moreover, there was non-significant mean coronal ONSD in comparison to mean axial ONSD in both groups. In accordance with our results Sitanaya et al [18] , discovered that groups with raised intracranial pressure had mean optic nerve sheath diameters that were larger than those in the control groups. Similar to our study, Wang et al's [19] findings showed a substantial difference in external ONSD in trauma patients.…”

A Narrative Review of Point of Care Ultrasound Assessment of the Optic Nerve in Emergency Medicine

“…Though there is recent evidence suggesting no difference in ONSD when measured between 3 and 5 mm posterior to the globe [ 45 ], most studies base their measurements at 3 mm [ 43 ]. The ONSD is measured between the outer hyperechoic borders of the subarachnoid space ( Figure 3 ) [ 2 , 46 ]. If no hyperechoic stripe is visualized, the diameter is measured at the border of the hypoechoic optic nerve and the hyperechoic retrobulbar fat [ 32 ].…”

Assessing Stress Induced by Fluid Shifts and Reduced Cerebral Clearance during Robotic-Assisted Laparoscopic Radical Prostatectomy under Trendelenburg Positioning (UroTreND Study)

“…In humans, a noninvasive estimation of the intracranial pressure and the detection of increased intracranial pressure can be achieved with the help of ultrasound-guided measurement of the optic nerve sheath diameter (ONSD). A non-invasive method to estimate changes in the ICP in humans is to measure the optical nerve sheath diameter (ONSD) using ultrasound [9][10][11]. Several studies on patients undergoing RALP have shown that the ONSD can increase significantly [12][13][14].…”