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Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage.
J Clin Neurosci. 2016 Dec; 34:177-181.JC

Abstract

The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6±0.8mm (cut-off value >5.5mm; p<0.05). ONSD/ETD ratio was 0.29±0.05 against normative 0.19±0.02 (p<0.01) with no correlation with initial Glasgow Coma Scale score or Hemispheric Stroke Scale score. There was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r=-0.7) and direct correlation with invasive ICP readings. This study provides further evidence that in patients with intracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD.

Authors+Show Affiliations

Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel. Electronic address: vaimed@yahoo.com.Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Department of Neurology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27612672

Citation

Vaiman, Michael, et al. "Noninvasive Assessment of the Intracranial Pressure in Non-traumatic Intracranial Hemorrhage." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 34, 2016, pp. 177-181.
Vaiman M, Sigal T, Kimiagar I, et al. Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage. J Clin Neurosci. 2016;34:177-181.
Vaiman, M., Sigal, T., Kimiagar, I., & Bekerman, I. (2016). Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 34, 177-181. https://doi.org/10.1016/j.jocn.2016.06.008
Vaiman M, et al. Noninvasive Assessment of the Intracranial Pressure in Non-traumatic Intracranial Hemorrhage. J Clin Neurosci. 2016;34:177-181. PubMed PMID: 27612672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage. AU - Vaiman,Michael, AU - Sigal,Tal, AU - Kimiagar,Itzhak, AU - Bekerman,Inessa, Y1 - 2016/09/06/ PY - 2016/03/16/received PY - 2016/04/02/revised PY - 2016/06/25/accepted PY - 2016/9/11/pubmed PY - 2017/2/6/medline PY - 2016/9/11/entrez KW - Adults KW - Computed tomography (CT) scan KW - Hemorrhagic stroke KW - Intracranial pressure KW - Non-traumatic intracerebral hemorrhage (ICH) KW - Optic nerve sheath diameter SP - 177 EP - 181 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 34 N2 - The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6±0.8mm (cut-off value >5.5mm; p<0.05). ONSD/ETD ratio was 0.29±0.05 against normative 0.19±0.02 (p<0.01) with no correlation with initial Glasgow Coma Scale score or Hemispheric Stroke Scale score. There was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r=-0.7) and direct correlation with invasive ICP readings. This study provides further evidence that in patients with intracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/27612672/Noninvasive_assessment_of_the_intracranial_pressure_in_non_traumatic_intracranial_hemorrhage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(16)30322-8 DB - PRIME DP - Unbound Medicine ER -