scholarly journals Sensitivity and specificity of Point-of-Care ocular ultrasound for optic neuritis: a hypothesis generating study

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Jason Arthur ◽  
Zachary Lewis ◽  
Brian Russ ◽  
Melissa P. Plumley ◽  
Anjali Patel ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Optic Disc ◽  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Optic Nerve Sheath Diameter ◽  
Ultrasound Finding ◽  
Perfect Agreement ◽  
Ocular Ultrasound ◽  
Optic Disc Elevation

Purpose: This retrospective study compares point-of-care ocular ultrasound to MRI in order to establish preliminary data for and identify challenges to a multicenter study into the utility of ocular ultrasound for diagnosing optic neuritis. Methods: Our ultrasound archive was queried to identify subjects suspected of having optic neuritis who underwent ocular ultrasound and MRI of the brain or orbit. Blinded ultrasounds were reviewed by ultrasound faculty. The presence of optic disc elevation, optic nerve, or sheath dilation, and overall impression were recorded and compared to MRI results. Sensitivity and specificity of each ultrasound finding and the overall impression, as well as agreement between the raters, were calculated. Results: Sensitivity and specificity of ultrasound for MRI confirmed optic neuritis was 100 % (95 % CI 54.1-100) and 58.3 % (95 % CI 27.7-84.8). Optic nerve sheath diameter had nearly perfect agreement (κ = 0.8828), however agreement on optic disc elevation (κ = 0.5641), nerve diameter (κ = 0.2174), and overall agreement (κ = 0.1818) were moderate, fair, and poor, respectively. Conclusions: This preliminary study estimates test characteristics of ocular ultrasound for the diagnosis of optic neuritis for the purposes of power analysis and to identify potential pitfalls in preparation for a larger prospective investigation.

Identification of Optic Disc Elevation and the Crescent Sign Using Point-of-Care Ocular Ultrasound in Children

2015 ◽  
Vol 31 (4) ◽  
pp. 304-307 ◽  
Author(s):  
Ronald F. Marchese ◽  
Rakesh D. Mistry ◽  
Richard J. Scarfone ◽  
Aaron E. Chen
Keyword(s):  
Optic Disc ◽  
Point Of Care ◽  
Crescent Sign ◽  
Ocular Ultrasound ◽  
Optic Disc Elevation

Abstract 334: Point-Of-Care Ultrasound in the Assessment of Optic Nerve Sheath Diameter After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Sarah E Kim ◽  
Richard Gordon ◽  
Benjamin Karfunkle ◽  
Pratik B Doshi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Optic Nerve ◽  
Neurological Outcome ◽  
Optic Nerve Sheath Diameter ◽  
Small Sample ◽  
Optic Nerve Sheath ◽  
Point Of Care Ultrasound ◽  
Nerve Sheath ◽  
Ocular Ultrasound ◽  
Linear Probe

Introduction: Hypoxic-ischemic injury from cardiac arrest may cause cerebral edema, leading to increased intracranial pressure (ICP) and brain tissue damage. Optic nerve sheath diameter (ONSD) is associated with elevated ICP. Limited clinical studies have reported ONSD changes in the early post-resuscitation time frame. We sought to evaluate the utility of bedside ocular ultrasound measurements in the assessment of post-cardiac arrest brain injury. Methods: We studied adult out-of-hospital cardiac arrests treated at an urban academic ED and achieving return of spontaneous circulation (ROSC) between May 2018 to May 2019. We included witnessed and unwitnessed arrest as well as shockable and non-shockable rhythms. After ROSC, trained emergency physicians performed bedside ultrasonographic assessment of bilateral ONSD at 1, 6, 24, 48, and 72 hours using an ocular preset on a 15MHz linear probe. ONSD measurements at these time frames were compared between groups stratified by rhythm type and neurological outcome. Cerebral performance category (CPC) was measured at 72 hours and at discharge. Results: Out of 48 eligible patients, 15 were excluded from the study due to lack of consent or available ultrasound images. We included 33 patients, of which 11 were female and 22 were male, with a median age of 57 (IQR 20). There were 19 with an initial rhythm of asystole or pulseless electrical activity (PEA), 9 with ventricular fibrillation arrests, and 5 with an unclear rhythm. At 1 hour, patients with CPC 1-2 had smaller ONSD compared to patients with CPC 3-5 (5.5mm vs 6.1mm, p=0.03). At 72 hour, patients with CPC score of 1-2 had an average reduction in ONSD of 1.6mm verses 0.29mm increase in patients with CPC 3-5. Despite small sample size, a trend towards higher ONSD were seen in patients with non-shockable vs shockable rhythm. Females were also consistently found to have smaller ONSD measurements in all time periods compared to males. Conclusions: This is the first study in the USA to perform analysis using ONSD measurements in cardiac arrest patients. Preliminary analysis of this on-going pilot revealed a greater improvement in ONSD diameters in patients with a favorable neurological outcome. OSND may have utility in prognostication of the post-arrest state.

scholarly journals Agreement Between Computed Tomography And Magnetic Resonance Imaging In Measuring Optic Nerve Sheath Diameter

2018 ◽  
Vol 10 (3) ◽  
pp. 22
Author(s):  
Haider N. Al-Tameemi ◽  
Neda M. Helel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Ct Scan ◽  
Optic Nerve Sheath Diameter ◽  
Resonance Imaging ◽  
Perfect Agreement ◽  
Nerve Sheath ◽  
The Brain ◽  
Ct And Mri

BACKGROUND: Neuroimaging is increasingly used as a non-invasive method to assess raised intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measurement using brain magnetic resonance imaging (MRI) has been shown to correlate well with invasively measured ICP, however little research has been conducted on the ONSD measurement using computerized tomography (CT) in correlation with ICP. This study was done to investigate whether CT scan can reliably replace MRI in measuring ONSD.METHOD: A cross-sectional comparative study was conducted on 50 adult patients (29 females and 21 males), who underwent both CT and MRI of the brain along 10-month period. Using the brain axial section, the transverse ONSD was measured at 3 mm behind the globe in both modalities. Agreement between CT and MRI readings was assessed using intraclass correlation (ICC) and Kappa method.RESULTS: There was a strongly positive and statistically significant correlation between ONSD measurement using CT scan and MRI (p value <0.001). There was almost perfect agreement between CT scan and MRI in measuring ONSD (ICC=0.987 and Kappa =0.837). Similar agreement was obtained when cases stratified into normal (≤ 5mm) and thickened (> 5mm) ONSD (ICC=0.947 and 0.972 respectively).CONCLUSION: CT scan is a reliable substitute for MRI in measuring ONSD with almost perfect agreement between the two modalities. It might be good practice to include ONSD measurement in the initial evaluation of brain CT scan in any patient with suspected raised ICP.

scholarly journals Elevated Intracranial Pressure Diagnosis with Emergency Department Bedside Ocular Ultrasound

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
D. Amin ◽  
T. McCormick ◽  
T. Mailhot
Keyword(s):  
Emergency Department ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Vision Loss ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Elevated Intracranial Pressure ◽  
Nerve Sheath ◽  
Ocular Ultrasound ◽  
Fundoscopic Examination

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.

scholarly journals Is Ocular Sonography a Reliable Method for the Assessment of Elevated İntracranial Pressure in Children?

2020 ◽  
Author(s):  
Dincer Yildizdas ◽  
Nagehan Aslan
Keyword(s):  
Intensive Care ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Point Of Care ◽  
Optic Nerve Sheath Diameter ◽  
Point Of Care Ultrasound ◽  
Raised Intracranial Pressure ◽  
Nerve Sheath ◽  
Retinal Artery ◽  
Doppler Indices

AbstractPoint-of-care ultrasound has been widely used by clinicians at the bedside in recent years. Various types of point-of-care ultrasound practices are employed, especially in pediatric emergency rooms and intensive care units. Pediatric intensive care specialists perform point-of-care ultrasound virtually as a part of physical examination since it provides just-in-time vital clinical information, which could assist in acute management strategies in critically ill patients. Measurement of optic nerve sheath diameter using point-of-care ultrasound is a noninvasive and radiation-free technique to determine raised intracranial pressure. Ophthalmic artery and central retinal artery Doppler indices can be used as transcranial Doppler to assess raised intracranial pressure. The aim of this review was to provide detailed information on ultrasonographic measurements of optic nerve sheath diameter and central retinal artery Doppler indices as techniques of interest for predicting increased intracranial pressure in pediatric patients in view of the literature.

Optic Nerve Sheath Diameter Measured by Point‐of‐Care Ultrasound and MRI

2020 ◽  
Vol 30 (6) ◽  
pp. 793-799
Author(s):  
Hamid Shokoohi ◽  
Matthew Pyle ◽  
Evan Kuhl ◽  
Michael A. Loesche ◽  
Aakshit Goyal ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Point Of Care ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Point Of Care Ultrasound ◽  
Nerve Sheath
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