Optic Nerve Sheath Diameter on Sonography in Idiopathic Intracranial Hypertension Versus Normal (original) (raw)
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Journal of the Neurological Sciences, 2016
Sonographic assessment of the optic nerve sheath diameter (ONSD) is a useful technique in detecting raised intracranial pressure (ICP) in neurocritical care patients. Its utility in idiopathic intracranial hypertension (IIH) is less known. The aim of this study was to evaluate the diagnostic accuracy of ONSD for detecting IIH. Material and methods: Ultrasound measurement of ONSD was performed in 19 patients with IIH and in 11 patients with different neurological diseases without raised ICP that required undergoing a lumbar puncture. The validity of this technique for diagnosing IIH was established with cerebrospinal fluid manometry values. Results: Patients with IIH showed significantly enlarged ONSD than those without IIH. The best cutoff point for detecting raised ICP was 6.3 mms, with a sensitivity, specificity and positive likelihood ratio of 94.7%, 90.9% and 10.4, respectively. After a therapeutic lumbar puncture an 87% of cases had a partial reduction of ONSD values. Conclusion: Sonographic assessment of ONSD seems to be a useful and reliable technique for detecting raised ICP. While the spinal manometry is not replaced in usual clinical settings, transorbital sonography alternatively allows a suitable and harmless screening of patients with suspected IIH. It would be desirable to perform an internal validation of the technique in each hospital in order to get the optimal cutoff point.
Objectives: To determine the predictive value of the measurement of the diameter of the optic nerve sheath (ONSD) with ocular ultrasonography compared to invasive intracranial pressure (ICP) measurement for the detection of intracranial hypertension (ICH). Design: Prospective, observational study. Setting: Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay. Patients: We studied 56 adult patients of both sexes, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring (patients with severe, traumatic and non-traumatic AEI) with a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU. Interventions: This was a study that utilized non-invasive (minimal risk) ultrasonography in patients admitted to the ICU. Measurements and main results: In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (...
Nöropsikiyatri arşivi, 2022
Introduction:Idiopathic intracranial hypertension (IIH) symptoms include headache, blurred vision, and papilledema which may lead to permanent vision loss unless diagnosed and treated. Definitive diagnosis of IIH usually requires the measurement of intracranial pressure (ICP) via lumbar puncture (LP) which is an invasive and unwanted technique for patients. In our study, optic nerve sheath diameters (ONSD) were measured before and after lumbar puncture in IIH patients and the relationship of these measurements with ICP changes was evaluated as well as the effect of decreasing cerebrospinal fluid (CSF) pressure after a lumbar puncture on ONSD. Thus, we want to investigate whether optic nerve ultrasonography (USG) is a useful tool instead of the invasive LP for the diagnosis of IIH.Methods:A total of 25 patients who applied to the neurology clinics of Ankara Numune Training and Research Hospital between May 2014 and December 2015 and were diagnosed with IIH were included in the study. The control group consisted of 22 individuals who applied with complaints other than headaches, visual impairment or tinnitus. Optic nerve sheath diameters were measured from both eyes before and after the LP. After pre-LP measurements were taken, opening and closing CSF pressure was measured. In the control group, ONSD was measured with optic USG.Results:Mean age of the IIH group and the control group was determined as 34.8±11.5 and 45.8±13.3 years, respectively. In the patient group, mean CSF opening pressure was 33.9±8.0 cm H2O and mean closing pressure was 18.1±4.7 cm H2O. Mean ONSD measured pre-LP was 7.1±1.0 mm in the right eye and 6.9±0.7 mm in the left eye, while mean post-LP ONSD was 6.7±0.9 mm in the right eye and 6.4±0.8 mm in the left eye. There was a statistically significant difference between ONSD values before and after the LP (p=0.006 for the right eye, p<0.001 for the left eye). In the control group, mean ONSD was 5.4±0.7 mm in the right eye and 5.5±0.6 mm in the left eye, and a statistically significant difference was found between ONSD values before and after the LP (p<0.001 for the right eye and left eye). A significant positive correlation was determined between left ONSD measurements before the LP and CSF opening pressure (r=0.501, p=0.011).Conclusions:In the present study, it was found that ONSD measurement by optic USG significantly displays increased ICP, and decreasing pressure via LP is rapidly reflecting ONSD measurement. Based on these findings, it is suggested that ONSD measurements by optic USG, a non-invasive method, can be used in the diagnosis and follow-up of IIH patients.
2020
Aim: Our aim was to measure optic nerve sheath diameter (ONSDM) by ultrasonography and to detect whether ONSDM reflected intracranial pressure in hypertensive patients. Materials and Methods: This observational study was performed prospectively in 149 individuals, 77 (51.7%) of whom were female, including 54 hypertensive-symptomatic patients, 45 hypertensive-asymptomatic patients, and 50 healthy volunteers referred to Emergency Medicine Service of Necmettin Erbakan University, Faculty of Medicine. Blood pressure was measured on the right and left upper extremities by the same sphygmomanometer following at least five minutes of rest. ONSDM was recorded. All measurements of hypertensive-symptomatic patients were repeated at 30th minute following antihypertensive therapy. Results: Moderate-to-well statistically significant correlations were determined between initial mean systolic blood pressure and ONSDM (rho=0.629, p=0.001) as well as between initial mean diastolic blood pressure and ONSDM (rho=0.561, p=0.001) in all study groups. Statistically significant differences were determined between the mean pre-and post-treatment systolic and diastolic blood pressures as well as the mean pre-and post-treatment ONSDM values of 40 patients who received antihypertensive therapy (p=0.000, p=0.000, p=0.000, respectively). Conclusion: Ultrasonographic ONSDM reflected increased intracranial pressure in hypertensive patients. The reduction of intracranial pressure was also detected by the same method following antihypertensive treatment. Ultrasonographic ONSDM along with clinical findings and blood pressure measurements may be used for evaluation of response to treatment and deciding on further imaging.
Medicine, 2016
Optic nerve sheath diameter (ONSD) seen on ocular US has been associated with increased intracranial pressure (IICP). However, most studies have analyzed normal range of ONSD and its optimal cutoff point for IICP in Caucasian populations. Considering ONSD differences according to ethnicity, previous results may not accurately reflect the association between IICP and ONSD in Koreans. Therefore, we conducted this study to investigate normal range of ONSD and its optimal threshold for detecting IICP in Korean patients. This prospective multicenter study was performed for patients with suspected IICP. ONSD was measured 3 mm behind the globe using a 13-MHz US probe. IICP was defined as significant brain edema, midline shift, compression of ventricle or basal cistern, effacement of sulci, insufficient gray/white differentiation, and transfalcine herniation by radiologic tests. The results of the ONSD are described as the median (25th-75th percentile). The differences of ONSD according to disease entity were analyzed. A receiver operator characteristic (ROC) curve was generated to determine the optimal cutoff point for identifying IICP. A total of 134 patients were enrolled. The patients were divided into 3 groups as follows: patients with IICP, n = 81 (60.5%); patients without IICP, n = 27 (20.1%); and control group, n = 26 (19.4%). ONSD in patients with IICP (5.9 mm [5.8-6.2]) is significantly higher than those without IICP (5.2 mm [4.8-5.4]) (P < 0.01) and normal control group (4.9 mm [4.6-5.2]) (P < 0.001). Between patients without IICP and normal control group, the difference of ONSD did not reach statistical significance (P = 0.31). ONSD >5.5 mm yielded a sensitivity of 98.77% (95% CI: 93.3%-100%) and a specificity of 85.19% (95% CI: 66.3%-95.8%). In conclusion, the optimal cutoff point of ONSD for identifying IICP was 5.5 mm. ONSD seen on ocular US can be a feasible method for detection and serial monitoring of ICP in Korean adult patients. Abbreviations: CT = computed tomography, ED = emergency department, ICU = intensive care unit, IICP = increased intracranial pressure, IIH = idiopathic intracranial hypertension, MRI = magnetic resonance imaging, ONSD = optic nerve sheath diameter, US = ultrasonography.
Ultrasonography, 2021
PURPOSE This study assessed the combined accuracy of optic nerve sheath diameter (ONSD), strain ratio (SR), and shear wave elastography (SWE) of the optic nerve (ON) in patients with idiopathic intracranial hypertension (IIH). METHODS This prospective study was carried out on both ONs of 34 consecutive patients diagnosed with IIH and 16 age- and sex-matched healthy volunteers. All of the study participants were women. The ONSD, SR, and SWE of the ON were measured. The severity of papilledema of IIH patients was sub-classified into mild papilledema and moderate/severe papilledema. RESULTS The mean ONSD (5.6±1.1 mm), SR (0.7±0.1), and SWE (30.1±16.7 kPa) of the IIH patients were significantly different (P=0.001) from the ONSD (4.1±0.5 mm), SR (0.9±0.1), and SWE (8.2±3.4 kPa) of controls. The cutoff values of ONSD, SR, and SWE of the ON for differentiating IIH patients from controls were 5.45 mm, 0.8, and 10.3 kPa with areas under the curve (AUCs) of 0.91, 0.86, and 0.96 and accuracy v...
American Journal of Ophthalmology, 2019
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2020
Background: Invasive monitoring of intracranial pressure is currently the only accepted method for the safe diagnosis and treatment of intracranial hypertension, but it is subject to hemorrhage, infection and malfunction. Ultrasound of the optic nerve sheath diameter is a non-invasive alternative that is cost effective and available at the bedside. The objective of this study was to correlate intracranial pressure and ultrasonography of the optic nerve sheath in an experimental animal model of cerebral hematoma. Materials and Methods: An experimental study was conducted on 30 male and female pigs wighing about 20 kg. The diameter of the optic nerve sheath was measured by ultrasound at different points of intracranial pressure. Intracranial pressure was simultaneously measured with an intraparenchymal catheter, and laboratory and hemodynamic data was collected from the animals. The values were correlated with each other to explore the application of this procedure in different clinical situations involving intracranial hypertension. Results: All the variables obtained by ONSD ultrasonography (Left Optic nerve LON, Rigth optic nerve RON and Avarage of Optic Nerve sheath AON) were statistically signi cant to predict the ICP value. AON presentation changes in relation to baseline from the moment of balloon in ation. AON proved to be the best parameter for predicting ICP and presented the best correlation. AON showed a delay of 30 minutes compared to ICP decrease, as it maintained values higher than baseline values at the ballon de ation moment (p = 0.016). Thus, intracranial pressure can be predicted using the linear function:-80.5 + 238.2 × the optic nerve sheath diameter. Conclusion: Optic nerve sheath diameter ultrasound is a reliable method for predicting intracranial pressure.
Cureus
Background Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) has been proposed as a noninvasive, bedside method to detect raised intracranial pressure (ICP) in various clinical settings. We aimed to correlate the ONSD obtained from ultrasonography with the gold standard, intraventricular ICP, and to find out the cutoff point which predicts ICP accurately at different levels. Methodology A prospective double-blind study was carried out by performing ocular ultrasounds in 30 adult patients with features of intracranial hypertension. The ONSD was measured by USG intraoperatively along with direct intraventricular pressure measurement. The ONSD was compared with the intraventricular ICP and correlations were derived. The optimum cutoff of ONSD to predict ICP > 20 mm Hg, 25 mm Hg, 30 mm Hg, and 35 mm Hg was sought. Results There was a significant correlation of ONSD with ICP (r = 0.532, p = 0.002). An ONSD threshold of 5.5 mm predicted ICP > 20 mm Hg with high sensitivity (100%) and specificity (75%) (area under receiver operating characteristic [ROC] curve = 0.904, p=0.01). The optimum ONSD cutoff predicting ICP at values of 25 mm Hg, 30 mm Hg, and 35 mm Hg was 6.3 mm, 6.5 mm, and 6.7 mm, respectively. Conclusion Our study confirms the utility of optic nerve ultrasound in the diagnostic evaluation of patients with known or suspected intracranial hypertension. We recommend an ONSD cutoff of 5.5 mm for predicting ICP > 20 mm Hg.
Journal of Clinical Neuroscience, 2021
Background: Invasive monitoring of intracranial pressure (ICP) is currently the gold standard method for the safe diagnosis and treatment of intracranial hypertension (ICHy), but it is subject to hemorrhage, infection and malfunction. Ultrasound of the optic nerve sheath diameter (ONSD) has been applied as a non-invasive alternative that is cost effective and available at the bedside. However, ONSD time-lapse behavior in a set of ICHy and its relief by means of whether saline infusion or surgery is still unknown. The objective of this study was to correlate intracranial pressure and ultrasonography of the optic nerve sheath in an experimental animal model of ICHy, and the interval needed to ONSD to return to its baseline levels. Methods: An experimental study was conducted on 30 male and female pigs weighing about 20 kg. The diameter of the optic nerve sheath was evaluated by ultrasound at different measures of ICP given by intraventricular catheter and intracranial balloon in ation, saline infusion and balloon de ation. Laboratory and hemodynamic data were collected from the animals. ICP and ONSD values were correlated at each time point of the study. Results: All the variables obtained by ONSD ultrasonography as left optic nerve, right optic nerve and average of optic nerve sheath (AON) diameter were statistically signi cant to estimate ICP value. ONSD values changed immediately at balloon in ation, with a delay of 30 minutes average to return to baseline levels after balloon de ation (p = 0.016). No statistical signi cance was observed in ICP and ONSD values with hypertonic saline infusion. Correlation between ICP and ONSD was linear and can be estimated using the formula:-80.5 + 238.2 x AON, in this swine model. Conclusion: In the present study, ultrasound of optic nerve sheath diameter disclosed linear correlation with ICP, although a short delay in returning to its baseline levels may be observed in the case of sudden intracranial hypertension relief.