Transocular ultrasound measurement of the optic nerve sheath diameter can identify elevated intracranial pressure in trauma patients

Bedside sonographic measurement of optic nerve sheath diameter can aid in the diagnosis of elevated intracranial pressure in the emergency department. This case report describes a 21-year-old female presenting with 4 months of mild headache and 2 weeks of recurrent, transient binocular vision loss. Though limited by patient discomfort, fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound (BOUS) revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. Lumbar puncture demonstrated a cerebrospinal fluid (CSF) opening pressure of 54 cm H2O supporting the suspected diagnosis of idiopathic intracranial hypertension. Accurate fundoscopy can be vital to the appropriate diagnosis and treatment of patients with suspected elevated intracranial pressure, but it is often technically difficult or poorly tolerated by the photophobic patient. BOUS is a quick and easily learned tool to supplement the emergency physician’s fundoscopic examination and help identify patients with elevated intracranial pressure.

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The relationship between computed tomography measurement of the optic nerve sheath diameter and elevated intracranial pressure in non-trauma patients

South African Journal of Radiology ◽

10.4102/sajr.v20i1.1060 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Daniël Luyt ◽

Delmé Hurter ◽

Gina Joubert

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Intracranial Pressure ◽

Digital Images ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Trauma Patients ◽

Cross Sectional ◽

Nerve Sheath ◽

The Brain

Background: The early detection and treatment of raised intracranial pressure (ICP) is critical in the prevention of mortality and morbidity as a result of secondary ischemic brain injury. Measuring the optic nerve sheath diameter (ONSD) on computed tomography (CT) to predict raised ICP may be useful in cases where routine CT investigations of the brain are indicated and invasive ICP monitoring is not available, or a lumbar puncture (LP) is contraindicated.Objective: The purpose of this study was to determine if the ONSD can be measured on digital images obtained by routine CT investigations of the brain, to identify patients with non-traumatic causes of elevated ICP, and to provide the observer with a non-invasive, objective measurement to predict elevated ICP.Method: We conducted a cross-sectional, retrospective analysis of anonymised patient data, comparing the ONSD on CT imaging with the opening pressure manometry during LP on patients who presented with focal neurology or with a Glasgow coma scale score of less than 15. The study sample consisted of 67 patients, ≥18 years of age, treated at the emergency department of the Kimberly Hospital Complex from 01 March 2013 to 31 December 2014.Results: An ONSD measurement of ≥4.8 mm identified patients with an elevated ICP with a sensitivity of 92.9% and a specificity of 97.6%, using a 95% confidence interval. Raising the ONSD cut-off value to ≥5.0 mm decreased the sensitivity to 85.7% but increased the specificity to 100%, eliminating all patients with a normal ICP.Conclusion: The ONSD can be measured on digital images obtained by routine CT investigations of the brain to predict elevated ICP in non-trauma patients, ≥18 years of age, with acceptable sensitivity and specificity.

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Transcranial Ultrasound to Detect Elevated Intracranial Pressure: Comparison of Septum Pellucidum Undulations and Optic Nerve Sheath Diameter

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2014.12.023 ◽

2015 ◽

Vol 41 (5) ◽

pp. 1233-1240 ◽

Cited By ~ 7

Author(s):

Susanne Bolesch ◽

Frederic von Wegner ◽

Christian Senft ◽

Matthias W. Lorenz

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Sheath Diameter ◽

Septum Pellucidum ◽

Optic Nerve Sheath ◽

Transcranial Ultrasound ◽

Elevated Intracranial Pressure ◽

Nerve Sheath

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How accurate is ultrasound of the optic nerve sheath diameter performed by inexperienced operators to exclude raised intracranial pressure?

South African Journal of Radiology ◽

10.4102/sajr.v19i1.745 ◽

2015 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

G. J. Du Toit ◽

D. Hurter ◽

M. Nel

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Lumbar Puncture ◽

Predictive Value ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Ultrasound Measurement ◽

Raised Intracranial Pressure ◽

Cross Sectional ◽

Nerve Sheath

Background: It has been well documented that ultrasound measurement of the optic nerve sheath diameter performed by an experienced operator shows good correlation with raised intracranial pressure, irrespective of the cause. Objective: To establish the accuracy of this technique performed by inexperienced operators.Method: A prospective analytical cross-sectional study was conducted. All patients ≥18 years of age who presented at our medical casualty and emergency departments with suspected meningitis were enrolled in the study. All patients were evaluated with the use of optic nerve sheath diameter ultrasound with or without computed tomography brain scan prior to lumbar puncture. Lumbar puncture opening pressure measurements were compared with the ultrasound measurements.Results: A total of 73 patients were enrolled in the study, of whom 14 had raised intracranial pressure. The study had a sensitivity of 50% (95% confidence interval (CI) 26.8%–73.2%) and specificity of 89.8% (95% CI 79.5%–95.3%) with a positive predictive value of 54.8% (95% CI 29.1%–76.8%) and negative predictive value of 88.3% (95% CI 77.8%–94.2%). The likelihood ratio of a positive test was 4.92 (95% CI 1.95–11.89) and that of a negative test 0.56 (95% CI 0.29–0.83). Cohen’s kappa value was 0.41 which indicates a moderate agreement. The receiver operating characteristic (ROC) curve had an area under the curve (AUC) of 0.73 (95% CI 0.51–0.95). Conclusion: Ultrasound measurement of the optic nerve sheath diameter can be used to exclude raised intracranial pressure, even in the hands of inexperienced operators.

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