Sonographic Measurement of Optic Nerve Sheath Diameter: A Prognostic Tool for Childhood Cerebral Malaria?

Abstract

Background: Childhood cerebral malaria is one of the most frequent complications of malaria, with high morbidity and mortality. Raised Intracranial Pressure (ICP) is currently recognized as a fundamental element of the severity of that disease. This study aims to look into the prognostic role of the sonographic measurement of optic nerve sheath diameter (ONSD) in the context of that disease. Methods: This study was conducted in the pediatric and imaging departments of the University Hospital Center of Parakou in Republic of Benin in West Africa. This was a descriptive cross-sectional study with a prospective data collection conducted over a period of 6 months, from March 1st to August 31st, 2014. There were two groups of children with severe malaria and conscious impairment: one with unrousable coma or Cerebral Malaria (Group 1) and the other without unrousable coma (Group 2), benefitting from ONSD sonographic measurement. ONSD was measured 3 mm behind the papilla. Correlation between depth of coma, outcome and ONSD measure on ultrasound was investigated. Results: Group 1 consisted of 37 children and Group 2 of 50 children, i.e. a sample of 87 children. The mean age was 27.21 ± 20.11 months and sex ratio (Male/Female) estimated at 0.89. The average ONSD of the sample was 4.39 ± 0.94 mm with a significant difference (p = 0.0001) between Group 1 (5.09 ± 1.09 mm) and Group 2 (3.87 ± 0.17 mm). Raised ICP prevalence was 48.28% with a significant difference between Group 1 (83.78%) and Group 2 (22%) with p < 0.0001. ONSD was higher in children with unfavorable clinical outcome than in those cured (p = 0.0012

Diagnostic value of the optic nerve sheath in the diagnosis of increased intracranial pressure in traumatic brain patients

“…The results of another study on a child with cerebral malaria also indicated that the measurement of ONSD by sonography can be used as a reliable approach for diagnosing and predicting the increase of ICP in these patients. [ 20 ] Although the examined patients were different from those of the present study, the findings of the aforementioned study regarding the relationship between ONSD and high ICP were similar to those of this study. Moreover, it seems that this measurement can be considered as a suitable and reliable diagnostic criterion for diagnosing high ICP in both adults and children.…”

Optic nerve sheath diameter and its association with brain swelling in pediatric cerebral malaria: a retrospective study

“…In pediatrics, increased ONSD has been associated with increased ICP in ventriculoperitoneal shunt failure, idiopathic intracranial hypertension, diabetic ketoacidosis, and traumatic brain injury (6)(7)(8)(9). The published results of ONSD measurement in CM have inconsistently demonstrated an association with depth of coma and/or long-term neurological outcome (13)(14)(15)(16). We developed our primary objective of determining if abnormally elevated admission ONSD correlates with an increased brain volume score (BVS) on MRI and our secondary objectives of examining if elevated ONSD correlates with an elevated opening pressure (OP) on lumbar puncture and a poor outcome at hospital discharge.…”