Sonographic Optic Nerve Sheath Diameter as a Screening Tool for Detection of Elevated Intracranial Pressure
Archives of Academic Emergency Medicine,
Vol. 1 No. 1 (2013),
2 July 2013
,
Page 15-19
https://doi.org/10.22037/aaem.v1i1.10
Abstract
Introduction: Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be reduced morbidity and mortality, and improved patients’ outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, respectively (P<0.0001). ROC curve demonstrated that the best cut off was 4.85 mm. Sensitivity, specificity, PPV, NPV, PLR, and NLR of ONSD for prediction of EICP were 96.4%, 95.3%, 72.2%, 98.9%, 20.6, and 0.04, respectively. Conclusion: Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident.
- Intracranial pressure
- traumatic brain injury
- ultrasonography
- optic nerve
- tomography
How to Cite
References
Montazeri A. Road-traffic-related mortality in Iran: a de-scriptive study. Public Health. 2004;118(2):110-3.
Vahedi K, Hofmeijer J, Juettler E, et al. Early decompres-sive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled tri-als. The Lancet Neurology. 2007;6(3):215-22.
Sankhyan N, Vykunta Raju KN, Sharma S, Gulati S. Man-agement of raised intracranial pressure. Indian J Pediatr. 2010;77(12):1409–16.
Tuite GF, Chong WK, Evanson J, et al. The effectiveness of papilledema as an indicator of raised intracrani al pressure in children with craniosynostosis. Neurosurgery. 1996;38(2): 272-8.
Hamilton DR, Sargsyan AE, Melton SL, et al. Sonography for determining the optic nerve sheath diameter with in-creasing intracranial pressure in a porcine model. J Ultra-sound Med. 2011;30(5):651-9.
Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Per-shad J. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pres-sure in children. Ann Emerg Med. 2009;53(6):785-91.
Akhavan Malayeri A, Bavarian S, Mehdizadeh M. So-nographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med. 2005;24(2):143–7.
Karakitsos D, Soldatos T, Gouliamos A, et al. Transorbital Sonographic Monitoring of Optic Nerve Diameter in Patients With Severe Brain Injury. Transplant Proc. 2006;38(10):3700-6.
Lagrèze WA, Lazzaro A, Weigel M, Hansen HC, Hennig J, Bley TA. Morphometry of the retrobulbar human optic nerve: comparison between conventional sonography and ultrafast magnetic resonance sequences. Invest Ophthalmol Vis Sci. 2007; 48(5):1913-7.
Amini A, Kariman H, Arhami Dolatabadi A, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. The American Journal of Emergency Medicine. 2012;31(1):236–9.
Ballantyne SA, O'Neill G, Hamilton R, Hollman AS. Ob-server variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound. 2002;15 (3):145-9.
Karim S, Clark RA, Poukens V, Demer JL. Demonstration of systematic variation in human intraorbital optic nerve size by quantitative magnetic resonance imaging and histology. Invest Ophthalmol Vis Sci. 2004;45(4):1047-51.
Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neu-rosurg. 1997; 87:34–40.
Hansen HC, Helmke K. The subarachnoid space sur-rounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18:323–8.
Skalka HW. Neural and dural optic nerve measurements with A-scan ultrasonography. South Med J. 1978;71:399–400.
Gangemi M, Cennamo G, Maiuri F, D'Andrea F. Echo-graphic measurement of the optic nerve in patients with in-tracranial hypertension. Neurochirurgia (Stuttg). 1987;30(2):53-5.
Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Semiz M. The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J. 2007;24(4):251-4.
Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008; 12(3):R67.
Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15(2):201-4.
Blaivas M, Theodoro D, Sierzenski PR. Elevated intracra-nial pressure detected by bedside emergency ultrasonogra-phy of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376-81.
Bäuerle J, Nedelmann M. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol. 2011;258(11):2014-9.
Geeraerts T, Merceron S, Benhamou D, Vigué B, Duran-teau J. Non-invasive assessment of intracranial pressure us-ing ocular sonography in neurocritical care patients. Inten-sive Care Med. 2008;34(11):2062-7.
Geeraerts T, Newcombe VF, Coles JP, et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care. 2008;12(5):R114.
Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508-14.
Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspi-cion of raised intracranial pressure. Emerg Med J. 2011;28 (8):679-81.
- Abstract Viewed: 282 times
- PDF Downloaded: 3025 times
