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Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage.
Neurocrit Care. 2009 Dec; 11(3):406-10.NC

Abstract

INTRODUCTION

The aim of our study is to confirm the reliability of optic nerve ultrasound as a method to detect intracranial hypertension in patients with spontaneous intracranial hemorrhage, to assess the reproducibility of the measurement of the optic nerve sheath diameter (ONSD), and to verify that ONSD changes concurrently with intracranial pressure (ICP) variations.

METHODS

Sixty-three adult patients with subarachnoid hemorrhage (n = 34) or primary intracerebral hemorrhage (n = 29) requiring sedation and invasive ICP monitoring were enrolled in a 10-bed multivalent ICU. ONSD was measured 3 mm behind the globe through a 7.5-MHz ultrasound probe. Mean binocular ONSD was used for statistical analysis. ICP values were registered simultaneously to ultrasonography. Twenty-eight ONSDs were measured consecutively by two different observers, and interobserver differences were calculated. Twelve coupled measurements were taken before and within 1 min after cerebrospinal fluid (CSF) drainage to control elevated ICP.

RESULTS

Ninety-four ONSD measurements were analyzed. 5.2 mm proved to be the optimal ONSD cut-off point to predict raised ICP (>20 mmHg) with 93.1% sensitivity (95% CI: 77.2-99%) and 73.85% specificity (95% CI: 61.5-84%). ONSD-ICP correlation coefficient was 0.7042 (95% CI for r = 0.5850-0.7936). The median interobserver ONSD difference was 0.25 mm. CSF drainage to control elevated ICP caused a rapid and significant reduction of ONSD (from 5.89 ± 0.61 to 5 ± 0.33 mm, P < 0.01).

CONCLUSION

Our investigation confirms the reliability of optic nerve ultrasound as a non-invasive method to detect elevated ICP in intracranial hemorrhage patients. ONSD measurements proved to have a good reproducibility. ONSD changes almost concurrently with CSF pressure variations.

Authors+Show Affiliations

Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15100 Alessandria, Italy. rmoretti@ospedale.al.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

19636971

Citation

Moretti, Riccardo, et al. "Reliability of Optic Nerve Ultrasound for the Evaluation of Patients With Spontaneous Intracranial Hemorrhage." Neurocritical Care, vol. 11, no. 3, 2009, pp. 406-10.
Moretti R, Pizzi B, Cassini F, et al. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009;11(3):406-10.
Moretti, R., Pizzi, B., Cassini, F., & Vivaldi, N. (2009). Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocritical Care, 11(3), 406-10. https://doi.org/10.1007/s12028-009-9250-8
Moretti R, et al. Reliability of Optic Nerve Ultrasound for the Evaluation of Patients With Spontaneous Intracranial Hemorrhage. Neurocrit Care. 2009;11(3):406-10. PubMed PMID: 19636971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. AU - Moretti,Riccardo, AU - Pizzi,Barbara, AU - Cassini,Fabrizio, AU - Vivaldi,Nicoletta, PY - 2009/7/29/entrez PY - 2009/7/29/pubmed PY - 2011/7/1/medline SP - 406 EP - 10 JF - Neurocritical care JO - Neurocrit Care VL - 11 IS - 3 N2 - INTRODUCTION: The aim of our study is to confirm the reliability of optic nerve ultrasound as a method to detect intracranial hypertension in patients with spontaneous intracranial hemorrhage, to assess the reproducibility of the measurement of the optic nerve sheath diameter (ONSD), and to verify that ONSD changes concurrently with intracranial pressure (ICP) variations. METHODS: Sixty-three adult patients with subarachnoid hemorrhage (n = 34) or primary intracerebral hemorrhage (n = 29) requiring sedation and invasive ICP monitoring were enrolled in a 10-bed multivalent ICU. ONSD was measured 3 mm behind the globe through a 7.5-MHz ultrasound probe. Mean binocular ONSD was used for statistical analysis. ICP values were registered simultaneously to ultrasonography. Twenty-eight ONSDs were measured consecutively by two different observers, and interobserver differences were calculated. Twelve coupled measurements were taken before and within 1 min after cerebrospinal fluid (CSF) drainage to control elevated ICP. RESULTS: Ninety-four ONSD measurements were analyzed. 5.2 mm proved to be the optimal ONSD cut-off point to predict raised ICP (>20 mmHg) with 93.1% sensitivity (95% CI: 77.2-99%) and 73.85% specificity (95% CI: 61.5-84%). ONSD-ICP correlation coefficient was 0.7042 (95% CI for r = 0.5850-0.7936). The median interobserver ONSD difference was 0.25 mm. CSF drainage to control elevated ICP caused a rapid and significant reduction of ONSD (from 5.89 ± 0.61 to 5 ± 0.33 mm, P < 0.01). CONCLUSION: Our investigation confirms the reliability of optic nerve ultrasound as a non-invasive method to detect elevated ICP in intracranial hemorrhage patients. ONSD measurements proved to have a good reproducibility. ONSD changes almost concurrently with CSF pressure variations. SN - 1556-0961 UR - https://www.unboundmedicine.com/medline/citation/19636971/Reliability_of_optic_nerve_ultrasound_for_the_evaluation_of_patients_with_spontaneous_intracranial_hemorrhage_ L2 - https://dx.doi.org/10.1007/s12028-009-9250-8 DB - PRIME DP - Unbound Medicine ER -