Noninvasive evaluation of intracranial hypertension? Is there a gold standard? (original) (raw)
Related papers
2013
Study objective: The objective of the present study is to determine whether a bedside ultrasonographic measurement of optic nerve sheath diameter and optic fundus examination can accurately predict the computed tomographic (CT) findings of elevated intracranial pressure in adult head injury patients in the emergency department (ED). METHODS: We conducted a prospective, blinded observational study on adult ED patients with suspected intracranial injury with possible elevated intracranial pressure. Exclusion criteria were age younger than 18 years or obvious ocular trauma. All patients underwent fundus examination by a single examiner immediate and after 6 hours of admission. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, a single optic nerve sheath diameter was measured 3 mm behind the globe in each eye. A mean binocular optic nerve sheath diameter greater than 5.00 mm was considered abnormal. Cranial CT findings of shift, edema, or effacement suggestive of elevated in...
International journal of radiology and diagnostic imaging, 2021
Increased intracranial pressure (ICP) is complication of traumatic brain injury. Early detection of raised ICP is helpful in timely treatment. Bed side ultrasound of optic nerve sheath is easier for detection of raised intracranial pressure by measuring its diameter. Our aim was to determine whether bedside ultrasound measurement of optic nerve sheath diameter (ONSD) can accurately predict raised intracranial pressure in head injury patients and to calculation of validity of test. Methods and Materials: Total 150 patients with head injury was first examined by ultrasound. The ONSD was measured 3 mm behind the globe perpendicular to long axis of globe in both eyes than mean binocular ONSD was calculated. Diameter more than 5 mm was considered abnormal. CT scan was performed in all patients and result was considered positive for elevated ICP if mid line shift, effacement of sulci, ventricles and cisterns are seen. Results: Out of total 150 patients 61 was female and 89 was male, age was ranging from 23-61 years. 30 patients showed mean binocular ONSD >5mm by ultrasound out of them 26 patients showed positive signs of raised intracranial pressure on CT. Sensitivity and negative predictive value of ultrasound to detect raised ICP was 100%, Specificity was 96.7 % and negative predictive value was 86.6 %. Conclusions: Ultrasound can be used as bed side screening tool to detect raised ICP in ICU patients and head trauma patients especially in hospital with high patient flow in emergency department.
Journal of the Neurological Sciences, 2016
Our objective was to apply the technique of measuring diameters of optic nerve sheath (ONSD) for the intracranial pressure assessment for the cases with traumatic head injury without hemorrhage. In a retrospective study, CT data of 720 adult patients were collected and analyzed. ONSDs were measured at the point where the ophthalmic artery crosses the optic nerve (anatomical landmark) together with the eyeball transverse diameter (ETD). The ONSD/ETD index was calculated. The correlation analysis was performed with gender, age, the Glasgow Coma Scale score, and the Glasgow Outcome Score. ONSD was enlarged in 82% cases (n = 591). Enlarged right/left ONSDs were 6.7 ± 1.0/6.7 ± 0.9 mm (cut-off value ˃ 5.5 mm). ONSD/ETD ratio was 0.28 ± 0.05 against 0.19 ± 0.02 in healthy adults (p = 0.02). We did not find correlation between ONSD/ETD ratio with initial Glasgow Coma Scale score but there was an inverse correlation between ONSD/ETD ratio and the Glasgow Outcome Score (r = −0.64). We conclude that in majority of cases with traumatic head injury without hemorrhage the ONSD is significantly enlarged indicating elevated intracranial pressure even if CT scans are negative.
International Journal of Research in Medical Sciences
Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negativ...
Journal of Advances in Medicine and Medical Research
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 ON...
Indicações de tomografia de crânio em crianças com trauma cranioencefálico leve
Revista do Colégio Brasileiro de Cirurgiões, 2013
The "Evidence Based Telemedicine -Trauma and Emergency Surgery" (TBE-CITE) performed a critical appraisal of the literature and selected the three most relevant and recent publications on the indications for head computed tomography (CT) scan in pediatric patients with mild traumatic brain injury (TBI). The first study identified patients with mild TBI, high and low risk factors for intracranial injuries detected on CT scan and the need for neurosurgical intervention. The second evaluated the guidelines of the National Institute of Clinical Excellence for pediatric patients with TBI. The outcome of this study was either performing a head CT scan or hospital admission. The last study identified and analyzed the patients in whom the CT scan is not necessary and consequently should not be routinely indicated. Based on the critical appraisal of the literature and expert discussion, the opinion of the TBE-CITE was to favor the adoption of the PECARN guidelines, proposing CT scans for children with GCS of 14, altered level of consciousness and palpable skull fracture, or when warranted by the physician experience, multiple findings or worsening symptoms.
Surgical Neurology International, 2019
Background: Measurement of optic nerve sheath diameter (ONSD) using ocular ultrasonography has shown a promise in predicting increased intracranial pressure (ICP). However, this method is dependent on operator technique and equipment availability. We propose an alternative method of measuring ONSD and Marshall score grading by utilizing initial computed tomography (CT) head obtained on admission. We believe that such a technique could help predict patients requiring an invasive ICP monitor on admission. Methods: Patients were retrospectively selected from the neurosurgery database of a level II trauma center. Control patients originated from a database of nontraumatic brain injury (TBI) patients with a negative CT head and no intracranial pathology. Study subjects included patients aged 18–90 years, who sustained a severe TBI requiring placement of an ICP monitor on admission. All patients had a non-contrast CT head before the placement of an ICP monitor. Patients receiving any inte...
Frontiers in Pediatrics
Background and AimsIntracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group.MethodsIn this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group.ResultsNinety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3–13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4–9.7] and th...
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 (...