Sonographic Measurement of Optic Nerve Sheath Diameter Todetect Findings of Increased Intracranial Pressure in Adult Head Injury Patients in Emergency Department of Tertiary Care Hospital

Abstract

Introduction:Raised intracranial pressure (ICP)is important to determine in traumatic & non-traumatic neurological and neurosurgical patients as it may cause signicant neurological deterioration due to secondary brain damage. Intra cranial pressure means exerted by uids such as cerebrospinal uid (CSF) inside the skull and on the brain tissue. So, a quick evaluation of increased ICP is important for the management of patients with traumatic brain injury (TBI) to allow timely intervention to decrease the ICP and maintain adequate cerebral perfusion. Aims: The aim was to evaluate use of bedside sonographic measurement of optic nerve sheath diameter (ONSD) to detect ndings of increased intracranial pressure in adult head injury patients in Emergency department. Methods: This prospective study was conducted at Emergency Medicine department of Mahatma Gandhi medical college & Hospital, Jaipur. Total 108 adult head injury patientswith suspected raised ICPwere included in this study. Bedside ultrasound was done for ONSD measurement, followed by a computed tomography (CT) of brain. Mechanism of injury, GCS, TBI classication, clinical featuresof increased ICP, mean ONSD of both eyes by USG and brain CT ndings of increased ICP were recorded.A mean bipolar ONSD > 5mm was considered abnormal. Result: Present study found Moderate head injury (57.4 %) as most common head injury. Mean ONSD in right eye was 5.964 with SD 0.822 and mean ONSD in left eye was 5.957 with SD 0.822.Total mean ONSD was >5mm was found in 84.25 % patients. Raised ICP features was present in 82.4 % CT brain.GCS score was inversely correlated with mean ONSD. Conclusion: We concluded that thesonographic measurement of optic nerve sheath diameter has excellent diagnostic accuracy to predict increased intracranial pressure in adult head injury patients in Emergency department