Optic nerve sheath diameter ultrasound measurement to evaluate cerebral edema in children with diabetic ketoacidosis

Abstract Background Cerebral edema is a fatal complication that can occur in children with diabetic ketoacidosis (DKA). Its clinical signs are generally not explicit, and subclinical cerebral edema can occur. This study is one of the few longitudinal studies conducted to identify cerebral edema in patients with DKA by measuring the optic nerve sheath diameter (ONSD). The aim of this study was to investigate cerebral edema in children with DKA with serial measurement of ONSD, which is an early and reliable indicator of cerebral edema, and to monitor changes in ONSD during therapy. Methods The study was conducted by measuring ONSD ultrasonographically at baseline and during the course of therapy in patients with DKA. All participants were diagnosed and received therapy at our unit between May 2016 and June 2017. The study was registered with the Clinical Trials database, with a study number of NCT02937441. Measurements were obtained while the patients were in the supine position with their eyes closed, and axial transbulbar images of both eyes were obtained with a 6–15-MHz linear probe. Results The ONSD values of children with DKA changed during the treatment, reaching the highest values at 12–16 h of therapy, and the greatest ONSD was observed in children who had moderate and severe DKA. Conclusions During treatment of children with DKA, it is possible to predict cerebral edema by measuring ONSD, and this may contribute to clinical management, especially fluid treatment.

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Ultrasound measurement of optic nerve diameter and optic nerve sheath diameter in healthy Chinese adults

BMC Neurology ◽

10.1186/s12883-015-0361-x ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 19

Author(s):

Han Chen ◽

Gui-Sheng Ding ◽

Yan-Chun Zhao ◽

Rong-Guo Yu ◽

Jian-Xin Zhou

Keyword(s):

Optic Nerve ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Ultrasound Measurement ◽

Chinese Adults ◽

Nerve Sheath ◽

Optic Nerve Diameter ◽

Healthy Chinese

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Bedside ultrasound measurement of optic nerve sheath diameter in patients with sepsis: a prospective observational study

Critical Care ◽

10.1186/s13054-020-02959-7 ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 3

Author(s):

Ziyue Yang ◽

Cuihong Qin ◽

Shuguang Zhang ◽

Shaohua Liu ◽

Tongwen Sun

Keyword(s):

Optic Nerve ◽

Observational Study ◽

Prospective Observational Study ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Bedside Ultrasound ◽

Ultrasound Measurement ◽

Nerve Sheath

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A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement

Critical Ultrasound Journal ◽

10.1186/s13089-016-0044-x ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 9

Author(s):

Frederick A. Zeiler ◽

Markus T. Ziesmann ◽

Patrick Goeres ◽

Bertram Unger ◽

Jason Park ◽

...

Keyword(s):

Optic Nerve ◽

Learning Curve ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Ultrasound Measurement ◽

Nerve Sheath ◽

Unique Method

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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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