Optic nerve sonographic examination to predict raised intracranial pressure in idiopathic intracranial hypertension: The cut-off points

Abstract

Purpose Monitoring of raised intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH) is required to prevent secondary optic nerve damage. Sonographic measurement of the optic nerve sheath diameter (ONSD) is a noninvasive method to evaluate intracranial hypertension. Different ONSD cut-off values have been reported probably due to ethnic variations. Our aim was to determine optic nerve sonographic examination cut-off points to predict raised ICP in IIH patients. Methods This case-control study was conducted on 99 IIH post-pubertal female patients (both probable and definite) and 35 age- and sex-matched healthy volunteers. Sonographic ONSD and optic nerve diameter (OND) were obtained 3 mm behind the posterior edge of the globe in a horizontal plane via a 7-13 MHz linear probe. Lumbar puncture was then carried out on the patients. Results The opening cerebrospinal fluid pressure documented in the patient group was 279.64 ± 65.97 mm HO. A statistically significant difference was found between IIH patients and controls regarding ONSD. The best ONSD cut-off value indicating raised ICP was 6.05 mm with an area under the curve of 0.850 (95% confidence interval 0.805 to 0.894, 73.2% sensitivity and 91.4% specificity). Regarding OND/ONSD ratio, there was an insignificant difference between both groups. Conclusion Sonographic ONSD but not OND/ONSD ratio could offer a bedside adjunct or alternative indicator of elevated ICP in IIH patients. Ethnic differences, however, should be noted when using this parameter.

Neuro-ophthalmological biomarkers of visual outcome in newly diagnosed idiopathic intracranial hypertension

“…Transorbital sonographic assessment of the ONSD is an easy, cost-effective non-invasive technique useful in detecting raised ICP [8]. The study showed that ONSD dilatation is a reliable confirmatory diagnostic test for raised ICP due to IIH but has a weak prognostic value as the degree of ONSD was not correlated with the degree of papilledema, and visual field affection as well as possible subsequent PVD.…”

“…Model: HD 11™ XE (Germany), multifrequency 2-5 MHz phased array transducer to measure the optic nerve sheath diameters (ONSD) while the patient lay in recumbent position and close his eyes. The ONSD was assessed 3 mm behind the lamina cribrosa (after the retroocular bullous end of the ON) at which the normative values of the ONSD range is 3.2-5 mm relied on the work of Kishk et al 2018 [8].…”

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

“…). 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.…”

<p>Evaluating optic nerve diameter as a possible biomarker for disability in patients with multiple sclerosis</p>

“…The anterior part of the optic nerve was depicted in an axial plane showing the papillae and the optic nerve in its longitudinal course. The measured parameters were the OND and the optic nerve sheath diameter (ONSD), which were measured 3 mm behind the posterior edge of the globe in a horizontal plane 14…”