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Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study.
Indian J Radiol Imaging. 2015 Apr-Jun; 25(2):173-6.IJ

Abstract

CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis.

OBJECTIVES

The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED).

MATERIALS AND METHODS

We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients.

RESULTS

The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001).

CONCLUSION

The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME.

Authors+Show Affiliations

Department of Emergency Medicine, BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India.Department of Emergency Medicine, BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25969641

Citation

Sangani, Shruti V., and Samira Parikh. "Can Sonographic Measurement of Optic Nerve Sheath Diameter Be Used to Detect Raised Intracranial Pressure in Patients With Tuberculous Meningitis? a Prospective Observational Study." The Indian Journal of Radiology & Imaging, vol. 25, no. 2, 2015, pp. 173-6.
Sangani SV, Parikh S. Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study. The Indian journal of radiology & imaging. 2015;25(2):173-6.
Sangani, S. V., & Parikh, S. (2015). Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study. The Indian Journal of Radiology & Imaging, 25(2), 173-6. https://doi.org/10.4103/0971-3026.155869
Sangani SV, Parikh S. Can Sonographic Measurement of Optic Nerve Sheath Diameter Be Used to Detect Raised Intracranial Pressure in Patients With Tuberculous Meningitis? a Prospective Observational Study. The Indian journal of radiology & imaging. 2015 Apr-Jun;25(2):173-6. PubMed PMID: 25969641.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study. AU - Sangani,Shruti V, AU - Parikh,Samira, PY - 2015/5/14/entrez PY - 2015/5/15/pubmed PY - 2015/5/15/medline KW - Ophthalmic Ultrasound KW - optic nerve sheath diameter KW - tuberculous meningitis SP - 173 EP - 6 JF - The Indian journal of radiology & imaging VL - 25 IS - 2 N2 - UNLABELLED: CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. OBJECTIVES: The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED). MATERIALS AND METHODS: We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients. RESULTS: The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001). CONCLUSION: The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME. SN - 0971-3026 UR - https://www.unboundmedicine.com/medline/citation/25969641/Can_sonographic_measurement_of_optic_nerve_sheath_diameter_be_used_to_detect_raised_intracranial_pressure_in_patients_with_tuberculous_meningitis_A_prospective_observational_study_ L2 - http://www.ijri.org/article.asp?issn=0971-3026;year=2015;volume=25;issue=2;spage=173;epage=176;aulast=Sangani DB - PRIME DP - Unbound Medicine ER -
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