Sonography of the optic nerve sheath beyond the hyperacute stage of intracerebral hemorrhage

Abstract

Purpose To evaluate the feasibility and utility of serial measuring of the optic nerve sheath diameter beyond the hyperacute and acute stage of intracerebral hemorrhage (ICH). Methods Four patients with extensive ICH in the left basal ganglia were followed using ultrasound (US) and cerebral CT scans. Results Optic nerve sheath diameter values assessed beyond the acute stage of ICH showed a high correlation (q = 0.84, p = 0.0022) with midline shift of the third ventricle seen on CT scans. Conclusions Optic nerve sonography can be useful to evaluate patients with extensive ICH beyond the acute stage and help monitoring clinical evolution in these patients, when ICP monitoring is not feasible.Keywords Cerebral computed tomography Á Intracerebral hemorrhage Á Intracranial pressure Á Optic nerve sheath diameter Riassunto Obiettivi Valutare l 0 utilità clinica della misurazione seriale del diametro del nervo ottico e dei suoi rivestimenti dopo la fase acuta dell 0 emorragia cerebrale. Metodi Quattro pazienti con emorragia cerebrale sono stati sottoposti ad ecografia del nervo ottico e tomografia assiale computerizzata (TAC) del cranio. Risultati I valori del diametro del nervo ottico e dei suoi rivestimenti correlavano in maniera marcata con lo shift della linea mediana del terzo ventricolo evidenziato alla TAC cerebrale. Conclusioni La sonografia del nervo ottico con la misurazione del diametro del nervo ottico e dei suoi rivestimenti potrebbe costituire un utile strumento nel valutare l'evoluzione clinica dei pazienti con estesa emorragia intracranica, qualora la misurazione della pressione intracranica non fosse eseguibile.

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

“…Previous studies showed a positive correlation between ONSD and hemorrhage volume or midline shift . In patients with ICH and elevated ICP, our work confirmed a good correlation between ONSD and hemorrhage volume at admission, but missed to find an association with midline shift.…”

“…Furthermore, the ONSD behavior in course of elevated ICP is not well‐established and this is particularly true for ICH patients where only a small case series have been evaluated for this purpose . In this regard, our data show that the widening of ONSD seems to persist over time, leading to the hypothesis that ICP remains elevated.…”

“…Ultrasonography of the optic nerve sheath diameter (ONSD) is a promising simple, noninvasive, repeatable, and bedside technique for the detection of increased ICP and, thus, particularly suitable in an intensive care or stroke‐unit setting . Recently, two studies demonstrated the reliability of ultrasonography of ONSD to identify raised ICP in ICH patients, but only one case series assessed the possible role of serial measurements of ONSD beyond the acute phase of ICH …”

“…[3][4][5] Recently, two studies demonstrated the reliability of ultrasonography of ONSD to identify raised ICP in ICH patients, but only one case series assessed the possible role of serial measurements of ONSD beyond the acute phase of ICH. [6][7][8] The central retinal artery and vein run closely inside the dura mater of the optic nerve and they are accessible to ultrasound through the identical transorbital acoustic window used for ONSD evaluation. 9 Considering their path, we speculated that ONSD enlargement during raised ICP could be transmitted into the intraaxial structures of the meningeal sheaths and, therefore, determine flow variations of Doppler parameters of retinal vessels.…”

The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study

“…ONSD measurement is proven to compare well with CT scan for the diagnosis of intracranial hypertension. However, previous studies were designed simply to confirm the association with intracranial hypertension, and/or were carried out primarily in patients with brain trauma, mountain sickness, cardiac arrest or in the emergency room/ triage evaluation [12, 19–53]. What has not been confirmed is whether the ONSD measurement performs well in comatose ICU patients and what is the optimal cut-off value to diagnose cerebral edema in this population.…”