Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure

IntroductionMeasurement of optic nerve sheath diameter (ONSD) by ultrasound is increasingly used as a marker to detect raised intracranial pressure (ICP). ONSD varies with age and there is no clear consensus between studies for an upper limit of normal. Knowledge of normal ONSD in a healthy population is essential to interpret this measurement.MethodsIn a prospective observational study, ONSD was measured using a 15 MHz ultrasound probe in healthy volunteers in Chittagong, Bangladesh. The aims were to determine the normal range of ONSD in healthy Bangladeshi adults and children, compare measurements in males and females, horizontal and vertical beam orientations and left and right eyes in the same individual and to determine whether ONSD varies with head circumference independent of age.Results136 subjects were enrolled, 12.5% of whom were age 16 or under. Median ONSD was 4.41 mm with 95% of subjects in the range 4.25–4.75 mm. ONSD was bimodally distributed. There was no relationship between ONSD and age (≥4 years), gender, head circumference, and no difference in left vs right eye or horizontal vs vertical beam.ConclusionsUltrasonographic ONSD in Bangladeshi healthy volunteers has a narrow bimodal distribution independent of age (≥4 years), gender and head circumference. ONSD >4.75 mm in this population should be considered abnormal.

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“…Its sensitivity for detecting raised ICP is high[5], [8] and ONSD varies almost concurrently with ICP [9]…”

Section: Introductionmentioning

confidence: 99%

Transorbital Sonographic Evaluation of Normal Optic Nerve Sheath Diameter in Healthy Volunteers in Bangladesh

et al. 2013

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“…Many studies have shown that ultrasound measurement of optic nerve sheath diameter provides accurate, reproducible information on the presence of elevated ICP. 9 This non-invasive technique has been used successfully in emergency rooms, [10][11][12] children with hydrocephalus, 13 and children with other causes of raised ICP. 14 We have previously established normative values for ONS diameter in Malawian children and showed the use of ONS ultrasound for detecting raised ICP in a resource-poor setting.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Raised Intracranial Pressure in Cerebral Malaria Detected by Optic Nerve Sheath Ultrasound

Beare¹,

Glover²,

Lewallen³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. We aimed to use optic nerve sheath (ONS) ultrasound to determine the prevalence of raised intracranial pressure (ICP) in African children with cerebral malaria (CM); and if increased ONS diameter is associated with poor outcome. We measured ONS diameter in 101 children with CM and 11 children with malaria and impaired consciousness in Malawi. The prevalence of raised ICP detected by increased ONS diameter was 49%. Case fatality was similar in children with increased ONS diameter on admission (9/55) and those children without increased ONS diameter (11/57). Neurological sequelae were more common in those children with increased ONS diameter (7/46 versus 2/46, P 0.05). Lumbar puncture (LP) opening pressure was elevated in 95% of 46 children who underwent LP. In Malawian children with CM, raised ICP is less commonly detected by ONS ultrasound than LP. This study suggests that raised ICP is not universal in CM and that other mechanisms may account for coma.

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“…Small adult studies have shown excellent sensitivity and specificity of ONSD measurements in the detection of increased ICP in both the emergency department and intensive care unit [70–73]. …”

Section: Diagnostic Applications Of Ultrasoundmentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure

Abstract: This study shows that ultrasound measurement of ONSD is sensitive and specific for raised ICP in the emergency department. Further observational studies are needed but this emerging technique could be used to focus treatment in unstable patients.

Cited by 79 publications

References 9 publications

Transorbital Sonographic Evaluation of Normal Optic Nerve Sheath Diameter in Healthy Volunteers in Bangladesh

Transorbital Sonographic Evaluation of Normal Optic Nerve Sheath Diameter in Healthy Volunteers in Bangladesh

Prevalence of Raised Intracranial Pressure in Cerebral Malaria Detected by Optic Nerve Sheath Ultrasound

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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