Normal Values of Optic Nerve Sheath Diameter on Computed Tomography and effect of Raised Intracranial Pressure on Head Injury Patients in North Central Nigeria

Aim: To establish a local nomogram of Computed Tomographic measurement of Optic Nerve Sheath Diameter and determine the values that can objectively predict raised intracranial pressure. Study design: observational retrospective study Place and duration of study: Department of Radiology of University of Abuja teaching hospital, Abuja from March 2016 to February 2020. Methodology: We included images of 356 patients referred to the Radiology department for brain CT. Data was grouped into three:(A) 200 non head injury patients as control,(B) head injury patients without radioclinical signs of raised ICP ,(C) head injury patients with at least one radiologic sign of raised ICP.ONSD obtained in axial scans at 3mm retrobulbar region at constant window width and level of 250/50 were analysed using SAS software version 9.3 and statistical level of significance set at 0.05. Result: Mean ONSD of 200 normal patients was 4.4mm± 0.5 with no significant correlation with age and side. Mean ONSD of 118 head injury patients with CT signs of raised ICP was 6.0mm±0.7 while mean ONSD of 38 head injury patients without CT signs of raised ICP was 4.3mm±0.7. ONSD was slightly higher in patients with significant midline shift compared with patients without shift but no correlation with degree of shift. The ONSD value above which raised ICP can be predicted with the highest sensitivity and specificity was >5.2mm with Receiver Operating Characteristic curve (ROC) demonstrating an area under the curve of 0.9796 (p-value < 0.0001) with specificity of 93.5% and sensitivity of 90.7%. Conclusion: There is a positive correlation between ONSD measurement on CT and intracranial pressure. This measurement is therefore recommended as an additional indirect radiological marker of raised ICP. Normal mean ONSD in a North-Central Nigerian population is 4.4mm± 0.5 with 5.2mm proposed as the upper limit of normal.

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Quality And Feasibility of Sonographic Measurement of the Optic Nerve Sheath Diameter to Estimate the Risk of Raised Intracranial Pressure After Traumatic Brain Injury in Prehospital Setting

Prehospital Emergency Care ◽

10.1080/10903127.2018.1501444 ◽

2018 ◽

Vol 23 (2) ◽

pp. 277-283 ◽

Cited By ~ 9

Author(s):

Charles-Henri Houzé-Cerfon ◽

Vincent Bounes ◽

Johanna Guemon ◽

Thibault Le Gourrierec ◽

Thomas Geeraerts

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Sheath Diameter ◽

Prehospital Setting ◽

Optic Nerve Sheath ◽

Raised Intracranial Pressure ◽

Nerve Sheath

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Evaluation of Optic Nerve Sheath Diameter and Transcranial Doppler As Noninvasive Tools to Detect Raised Intracranial Pressure in Children

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002523 ◽

2020 ◽

Vol 21 (11) ◽

pp. 959-965

Author(s):

Indar Kumar Sharawat ◽

Ananthanarayanan Kasinathan ◽

Arun Bansal ◽

Jitendra Kumar Sahu ◽

Kushaljit Singh Sodhi ◽

...

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Transcranial Doppler ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Raised Intracranial Pressure ◽

Nerve Sheath

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Measurement of Optic Nerve Sheath Diameter for the Assessment of Risk of Raised Intracranial Pressure

European Neurological Review ◽

10.17925/enr.2009.04.01.50 ◽

2009 ◽

Vol 4 (1) ◽

pp. 50 ◽

Cited By ~ 2

Author(s):

Thomas Geeraerts ◽

David K Menon ◽

Dan Benhamou ◽

◽

...

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Brain Magnetic Resonance Imaging ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Raised Intracranial Pressure ◽

Nerve Sheath ◽

Patients At Risk ◽

The Central Nervous System ◽

Magnetic Resonance Imaging Mri

Raised intracranial pressure (ICP) is associated with poor outcome after brain injury, but is difficult to detect without invasive devices. As a part of the central nervous system, the optic nerve is surrounded by a dural sheath, and the subarachnoid space surrounding the optic nerve is subject to the same pressure changes as the intracranial compartment. Distension of the optic nerve sheath reflects an increase in cerebrospinal fluid (CSF) pressure and can be used to estimate the risk of raised ICP. Ocular sonography or brain magnetic resonance imaging (MRI) enables valid measurement of the distension of the dural sheath surrounding the optic nerve. An optic nerve sheath diameter greater than 5.8mm is likely to be associated with raised ICP. This non-invasive estimate of ICP may detect patients at risk, help make decisions regarding the placement of invasive ICP devices and allow the selection of patients for transfer to specialist centres.

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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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