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VOLUME 18 , ISSUE 11 ( November, 2014 ) > List of Articles


Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study

Chetan Shirodkar, Dnyaneshwar Mutkule, Yogesh Harde, Pradeep Venkategowda, M. Mahesh

Keywords : Computed tomography, intensive care unit, magnetic resonance imaging, mannitol, optic nerve sheath diameter, raised intracranial pressure, ultrasonography

Citation Information : Shirodkar C, Mutkule D, Harde Y, Venkategowda P, Mahesh M. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study. Indian J Crit Care Med 2014; 18 (11):728-734.

DOI: 10.4103/0972-5229.144015

License: CC BY-ND 3.0

Published Online: 01-09-2008

Copyright Statement:  Copyright © 2014; The Author(s).


Background and Aims: The aim was to evaluate efficacy of optic nerve sheath diameter (ONSD) by ultrasound as a noninvasive method for detecting raised intracranial pressure (ICP) in intensive care unit, to compare with computed tomography/magnetic resonance imaging (MRI) findings of raised ICP and to prognosticate ONSD value with treatment. Materials and Methods: We conducted a prospective, observational study on 101 adults by including 41 healthy individuals in group A as control and 60 patients in group B admitted with fever, headache, vomiting, and altered sensorium. We examined them in supine position using 10 MHz linear array probe on closed eyelid. ONSD was measured 3 mm behind the globe in each eye. A mean binocular ONSD > 4.6 mm in female and 4.8 mm in male was considered abnormal. Midline shift, edema, effacement or ONSD > 5.0 mm on T2 MRI suggestive of elevated ICP was used to evaluate ONSD accuracy. Results: Group A mean ONSD was 4.6 mm in females and 4.8 mm in males. Group B mean ONSD for 17 females was 5.103 ± 0.6221 mm (P = 0.002) and for 43 males 5.081 ± 0.5799 mm (P = 0.032). Radiological sign of raised ICP was confirmed in 35 patients (females = 11 and males = 24) with high ONSD value. Sensitivity of detecting raised ICP by ONSD was 84.6% in females and 75% in males while specificity was 100% in both genders. Out of 25 patients without radiological signs of raised ICP 10 patients showed high ONSD (females = 4.735 mm and males = 4.907 mm). ONSD was well prognosticated with treatment modalities. Conclusion: Bedside ocular ultrasonography for measuring ONSD can be used an early test for diagnosing raised ICP as it is a noninvasive, cost effective bedside test, which can be repeated for re-evaluation.

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  1. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: A pooled analysis of three randomised controlled trials. Lancet Neurol 2007;6:215-22.
  2. Ware AJ, D′Agostino AN, Combes B. Cerebral edema: A major complication of massive hepatic necrosis. Gastroenterology 1971;61:877-84.
  3. Quagliarello V, Scheld WM. Bacterial meningitis: Pathogenesis, pathophysiology, and progress. N Engl J Med 1992;327:864-72.
  4. Newton CR, Crawley J, Sowumni A, Waruiru C, Mwangi I, English M, et al. Intracranial hypertension in Africans with cerebral malaria. Arch Dis Child 1997;76:219-26.
  5. Pedersen M, Brandt CT, Knudsen GM, Ostergaard C, Skinhüj P, Frimodt-Müller N, et al. Cerebral blood flow autoregulation in early experimental S. pneumoniae meningitis. J Appl Physiol (1985) 2007;102:72-8.
  6. Bergman R, Tjan DH, Adriaanse MW, van Vugt R, van Zanten AR. Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia. Resuscitation 2008;76:142-5.
  7. Calvo A, Hernández P, Spagnuolo E, Johnston E. Surgical treatment of intracranial hypertension in encephalic cryptococcosis. Br J Neurosurg 2003;17:450-5.
  8. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med 2004;30:1579-85.
  9. Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 1996;18:323-8.
  10. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 1996;26:701-5.
  11. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol 1996;26:706-10.
  12. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg 1997;87:34-40.
  13. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: A systematic review and meta-analysis. Intensive Care Med 2011;37:1059-68.
  14. Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S, Benhamou D, Mercier FJ, et al. Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: A pilot study. Anesthesiology 2012;116:1066-71.
  15. Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011;15:506-15.
  16. Geeraerts T, Newcombe VF, Coles JP, Abate MG, Perkes IE, Hutchinson PJ, et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 2008;12:R114.
  17. Mokri B. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology 2001; 56(12):1746-8.
  18. Kelly G. Appearances observed in the dissection of two individuals; death from cold and congestion of the brain. Trans Med Chir Sci Edinb 1824;1:84-169.
  19. Steiner LA, Andrews PJ. Monitoring the injured brain: ICP and CBF. Br J Anaesth 2006;97:26-38.
  20. Ghajar J. Traumatic brain injury. Lancet 2000;356:923-9.
  21. Ossoinig KC. Standardized echography: Basic principles, clinical applications, and results. Int Ophthalmol Clin 1979;19:127-210.
  22. Cennamo G, Gangemi M, Stella L. The correlation between endocranial pressure and optic nerve diameter: An ultrasonographic study. Ophthal Echography 1987;7:603-6.
  23. Gangemi M, Cennamo G, Maiuri F, D′Andrea F. Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987;30:53-5.
  24. Tamburelli C, Aricle C, Mangiola A. CSF dynamic parameters and changes of optic nerve diameters measured by standardised echography. Ophthal Echography 1993;13:101-9.
  25. Hansen HC, Helmke K, Kunze K. Optic nerve sheath enlargement in acute intracranial hypertension. Neuroophthalmology 1994;14:345-54.
  26. Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol 1993;116:548-56.
  27. Dutton JJ. Optic nerve sheath meningiomas. Surv Ophthalmol 1992;37:167-83.
  28. Beare NA, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, et al. Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health 2008;13:1400-4.
  29. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007;49:508-14.
  30. Johnson LN, Hepler RS, Bartholomew MJ. Accuracy of papilledema and pseudopapilledema detection: A multispecialty study. J Fam Pract 1991;33:381-6.
  31. O′Sullivan MG, Statham PF, Jones PA, Miller JD, Dearden NM, Piper IR, et al. Role of intracranial pressure monitoring in severely head-injured patients without signs of intracranial hypertension on initial computerized tomography. J Neurosurg 1994;80:46-50.
  32. Winkler F, Kastenbauer S, Yousry TA, Maerz U, Pfister HW. Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis. J Neurol 2002;249:1292-7.
  33. Hiler M, Czosnyka M, Hutchinson P, Balestreri M, Smielewski P, Matta B, et al. Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg 2006;104:731-7.
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