scholarly journals Bedside Ultrasonography as an Alternative to Computed Tomography Scan for the Measurement of Optic Nerve Sheath Diameter

2018 ◽  
Vol 09 (02) ◽  
pp. 252-255
Author(s):  
Uday Yanamandra ◽  
Amul Gupta ◽  
Sushma Yanamandra ◽  
Subrat Kumar Das ◽  
Sagarika Patyal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Optic Nerve ◽  
Ct Scan ◽  
High Altitude ◽  
Surrogate Marker ◽  
Correlation Coefficients ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Visual Axis ◽  
Nerve Sheath

ABSTRACT Background: Optic nerve sheath diameter (ONSD) as measured by optic nerve sheath ultrasonography (ONSU) is used as a surrogate marker of intracranial pressure (ICP), especially in resource-limited settings. There is a growing interest in the use of ONSU in emergency and high-altitude setups. Notwithstanding multiple studies done on this subject, there is a paucity of data regarding standardization of techniques and comparison of ONSU with computed tomography (CT). Materials and Methods: Thirty-five patients with a diagnosis of high-altitude cerebral edema were enrolled in the study. ONSD was measured in all patients using ONSU, along visual and coronal axis, and CT scan. We repeated ONSU in these patients on days 3, 7, 10, and 15 (day of discharge). Correlation between visual and coronal axis as well as CT scan was analyzed. Results: The correlation of visual to coronal and coronal to visual was equally significant (both correlation coefficients being R 2 = 0.983). Correlation of ONSD by visual axis to CT scan was better than coronal axis (correlation coefficient R 2 = 0.986 vs. 0.96, respectively). Conclusion: In our study, we found a strong correlation between the visual and coronal axes. Thus, either of the two axes can be used for monitoring ICP. However, it has been found that measurements along the coronal axis are challenging, especially in the emergency setup. ONSD measured along visual axis correlated better with CT scan as compared to the coronal axis.

Optic nerve sheath diameter changes at high altitude and in acute mountain sickness: meta-regression analyses

2020 ◽  
pp. bjophthalmol-2020-317717
Author(s):  
Tou-Yuan Tsai ◽  
George Gozari ◽  
Yung-Cheng Su ◽  
Yi-Kung Lee ◽  
Yu-Kang Tu
Keyword(s):  
Optic Nerve ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cochrane Library ◽  
Regression Analyses ◽  
Spline Regression ◽  
Nerve Sheath ◽  
Mountain Sickness

Background/aimsTo assess changes in optic nerve sheath diameter (ONSD) at high altitude and in acute mountain sickness (AMS).MethodsCochrane Library, EMBASE, Google Scholar and PubMed were searched for articles published from their inception to 31st of July 2020. Outcome measures were mean changes of ONSD at high altitude and difference in ONSD change between subjects with and without AMS. Meta-regressions were conducted to investigate the relation of ONSD change to altitude and time spent at that altitude.ResultsEight studies with 248 participants comparing ONSD from sea level to high altitude, and five studies with 454 participants comparing subjects with or without AMS, were included. ONSD increased by 0.14 mm per 1000 m after adjustment for time (95% CI: 0.10 to 0.18; p<0.01). Restricted cubic spline regression revealed an almost linear relation between ONSD change and time within 2 days. ONSD was greater in subjects with AMS (mean difference=0.47; 95% CI: 0.14 to 0.80; p=0.01; I2=89.4%).ConclusionOur analysis shows that ONSD changes correlate with altitude and tend to increase in subjects with AMS. Small study number and high heterogeneity are the limitations of our study. Further large prospective studies are required to verify our findings.

scholarly journals Optic nerve sheath diameter as a predictor of acute cerebellar infarction in acute vertigo patients without brain computed tomography abnormalities

2019 ◽  
Vol 27 (3) ◽  
pp. 168-175
Author(s):  
Myoung Sun You ◽  
Sun Hwa Lee ◽  
Seong Jong Yun ◽  
Seokyong Ryu ◽  
Seung Woon Choi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Optic Nerve ◽  
Confidence Interval ◽  
Operating Characteristic ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebellar Infarction ◽  
Resonance Imaging ◽  
Acute Infarction ◽  
Nerve Sheath

Background and objectives: To date, no study has investigated the ability of optic nerve sheath diameter calculated from non-contrast brain computed tomography to predict acute cerebellar infarction in patients with acute vertigo. The aim of our study was to evaluate the predictive utility of optic nerve sheath diameter for diagnosing acute cerebellar infarction in patients with acute vertigo without computed tomography abnormalities. Methods: We retrospectively enrolled patients with acute vertigo without computed tomography abnormalities who underwent magnetic resonance imaging including diffusion-weighted imaging at our emergency department between January 2016 and December 2017. Two emergency physicians independently measured optic nerve sheath diameter at 3 mm (ONSD3) and 10 mm (ONSD10) behind the globe in each patient. Final magnetic resonance imaging reports with clinical progress notes were used as the reference standard. A multivariate logistic regression analysis, receiver operating characteristic curves, and intra-class correlation coefficients were calculated to estimate predictive value. Results: A total of 34 patients (16.1%) were diagnosed with acute infarction and 177 patients (83.9%) were diagnosed with peripheral vertigo. Mean ONSD3 ( p < 0.001) and ONSD10 ( p < 0.001) were independent predictive factors for distinguishing acute infarction and peripheral vertigo. ONSD3 (cut-off = 4.22 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 97.7% (95% confidence interval = 95.1–99.6) specificity with area under the receiver operating characteristic curve of 0.988 (95% confidence interval = 0.978–1.0), while ONSD10 (cut-off = 3.63 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 87.6% (95% confidence interval = 81.8–92.0) specificity with area under the receiver operating characteristic curve of 0.976 (95% confidence interval = 0.959–0.997). There were good inter- and intra-observer agreements for both sides of ONSD3 and ONSD10 (intra-class correlation coefficient range = 0.652–0.773). Conclusion: Optic nerve sheath diameter, in particular OSND3, is a feasible predictive marker for acute infarction in patients with acute vertigo without computed tomography abnormalities. This information can assist decision-making in ordering brain magnetic resonance imaging for the assessment of acute vertigo.

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

2016 ◽  
Vol 20 (1) ◽  
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.

scholarly journals KORELASI DIAMETER SELUBUNG NERVUS OPTIK DAN MARSHALL CT SCORE DENGAN SKALA KOMA GLASGOW PADA CEDERA KEPALA

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Rani Maria Yogipranata ◽  
Hermina Sukmani
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Coma Scale ◽  
Nerve Sheath

CORRELATION BETWEEN OPTIC NERVE SHEATH DIAMETER AND MARSHALL CT SCORE WITH GLASGOW COMA SCALE IN TRAUMATIC BRAIN INJURYABSTRACTIntroduction: In traumatic brain injury (TBI), non-contrast brain CT scan is able to detect an increase in intracranial pressure, which is crucial in patient’s management. Optic nerve sheath diameter’s (ONSD) measurement is a new method that is expected to assess an increase in intracranial pressure noninvasively. Marshall CT score is a valid instrument, a de facto standard to classify head injury patient which correlates with an increased intracranial pressure.Aims: To see the correlation between ONSD and Marshall CT score with Glasgow Coma Scale (GCS).Methods: This was a retrospective, analytic observational with cross-sectional research’s design taken from the patients’ medical record admitted in Dr. Kariadi Hospital, Semarang, between March-August 2017. Measurement of ONSD and Marshall CT score were done by a radiologist. Rank Spearman’s were used to assess the correlation between variables.Results: There were 34 subjects, the majority were man (67,6%), with highest incidents in less than 30 years age (41,2%) and mostly caused by accident  (76,4%). Statistical analysis showed a moderate negative degree correlation between ONSD and Marshall CT score with GCS.Discussion: Enlargement of ONSD and higher Marshall CT score were correlated negatively related with the GCSin TBI patients with increased intracranial pressure.Keywords: Glasgow Coma Scale, Marshall CT score, optic nerve sheath diameter’s, traumatic brain injuryABSTRAK Pendahuluan: Pada cedera kepala atau traumatic brain injury (TBI), penggunaan CT scan kepala tanpa kontras dapat mendeteksi tanda-tanda peningkatan tekanan intrakranial (TIK), yang penting bagi tata laksana pasien. Sementara pengukuran diameter optic nerve sheath yang disebut optic nerve sheath diameter (ONSD) merupakan metode baru yang diharapkan dapat menilai peningkatan tekanan intrakranial secara non-invasif. Marshall CT score merupakan instrumen valid dan menjadi standar de facto dalam mengklasifikasikan pasien cedera kepala yang berkorelasi dengan peningkatan TIK.Tujuan: Untuk melihat adanya korelasi antara diameter N. Optikus dan Marshall CT score dengan Skala KomaGlasgow (Glasgow Coma Scale/GCS).Metode: Penelitian analitik observasional retrospektif secara potong lintang dari data rekam medis pasien cedera kepala dewasa yang dirawat di RSUP Prof. Dr. Kariadi, Semarang, pada bulan Maret-Agustus 2017. Selanjutnya kesemua subjek dilakukan pengukuran ONSD pada kedua mata serta penilaian Marshall CT score oleh seorang spesialis radiologi. Dilakukan uji korelasi Rank Spearman’s untuk menilai ketiga parameter tersebut.Hasil: Terdapat 34 subjek yang terutama laki-laki (67,6%) dengan usia terbanyak <30 tahun (41,2%) dan penyebab terbanyak adalah kecelakaan (76,4%). Didapatkan korelasi negatif derajat sedang antara ONSD dan Marshall CT score dengan GCS.Diskusi: Peningkatan diameter optic nerve sheath dan Marshall CT score berkorelasi dengan penurunan skor GCSpada pasien cedera kepala yang mengalami peningkatan TIK.Kata kunci: Cedera kepala, diameter optic nerve sheath, Marshall CT score, Skala Koma Glasgow

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