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Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound.
Cureus 2019; 11(2):e4145C

Abstract

Background The early detection of elevated intracranial pressure (ICP) can not only prevent mortality but also aid in more aggressive management. Brain computed tomography (CT) is a mainstay modality in detecting elevated ICP, but the feasibility of using brain CTs to detect elevated ICP in critically ill patients is limited, especially for patients who require high levels of inotropic support. The optic nerve sheath is a direct extension of the brain meninges. Therefore, the elevation of ICP is directly transmitted to the sheath. Measuring the optic nerve sheath diameter (ONSD) through ultrasound (US) is a bedside, noninvasive means to detect elevated ICP. The goal of this study was to assess the correlation of ONSD with elevated ICP as measured via US in an intensive care unit (ICU). Methods We conducted a six-month prospective, single-center, observational study of mass effect stroke patients aged 18 to 65 years who had a traumatic brain injury (TBI) and were admitted to the ICU. Patients with chronic hydrocephalus, extensive local orbit trauma, a pre-existing ocular disease affecting the optic nerve and/or orbital cavity, hyperthyroidism with exophthalmos, and facial trauma affecting the orbits and/or eyeballs were excluded. We measured the ONSD at the entry of optic nerve into the globe using two-dimensional (2D) US. Results One hundred patients were included in the study. Forty-nine patients had diffuse cerebral edema detected on CT scan correlating with increased ONSD notable via bedside US. The mean ONSD related to CT-detectable elevated ICP was 0.61 cm. The sensitivity for the ONSD cut-off value of ≥5.8 mm was 94% (95% confidence interval [CI], 84.05% to 98.79%), and the specificity was 96.08% (95% CI, 86.7% to 99.52%).The positive predictive value was 92.08% (95% CI, 86.28% to 98.96%), and the negative predictive value was 94.23% (95% CI, 84.47% to 98.00%). Conclusion The greatest accuracy in ONSD was found with a cut-off of >0.58 cm in patients with positive CT brain findings. Therefore, US can be used as an initial screening test when physicians suspect a patient has elevated ICP.

Authors+Show Affiliations

Internal Medicine, Shifa International Hospital, Islamabad, PAK.Internal Medicine, Shifa International Hospital, Islamabad, PAK.Internal Medicine, Khan Research Laboratories Hospital, Islamabad, PAK.Internal Medicine, Shifa International Hospital, Islamabad, PAK.Internal Medicine, Shifa International Hospital, Islamabad, PAK.Internal Medicine, Shifa International Hospital, Islamabad, PAK.Internal Medicine, Shifa International Hospital, Islamabad, PAK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31058028

Citation

Munawar, Kamran, et al. "Optic Nerve Sheath Diameter Correlation With Elevated Intracranial Pressure Determined Via Ultrasound." Cureus, vol. 11, no. 2, 2019, pp. e4145.
Munawar K, Khan MT, Hussain SW, et al. Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound. Cureus. 2019;11(2):e4145.
Munawar, K., Khan, M. T., Hussain, S. W., Qadeer, A., Shad, Z. S., Bano, S., & Abdullah, A. (2019). Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound. Cureus, 11(2), pp. e4145. doi:10.7759/cureus.4145.
Munawar K, et al. Optic Nerve Sheath Diameter Correlation With Elevated Intracranial Pressure Determined Via Ultrasound. Cureus. 2019 Feb 27;11(2):e4145. PubMed PMID: 31058028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound. AU - Munawar,Kamran, AU - Khan,Muhammad Tariq, AU - Hussain,Syed Waqar, AU - Qadeer,Aayesha, AU - Shad,Zahid Siddique, AU - Bano,Sheher, AU - Abdullah,Azmat, Y1 - 2019/02/27/ PY - 2019/5/7/entrez PY - 2019/5/7/pubmed PY - 2019/5/7/medline KW - icp KW - icu KW - onsd KW - tbi SP - e4145 EP - e4145 JF - Cureus JO - Cureus VL - 11 IS - 2 N2 - Background The early detection of elevated intracranial pressure (ICP) can not only prevent mortality but also aid in more aggressive management. Brain computed tomography (CT) is a mainstay modality in detecting elevated ICP, but the feasibility of using brain CTs to detect elevated ICP in critically ill patients is limited, especially for patients who require high levels of inotropic support. The optic nerve sheath is a direct extension of the brain meninges. Therefore, the elevation of ICP is directly transmitted to the sheath. Measuring the optic nerve sheath diameter (ONSD) through ultrasound (US) is a bedside, noninvasive means to detect elevated ICP. The goal of this study was to assess the correlation of ONSD with elevated ICP as measured via US in an intensive care unit (ICU). Methods We conducted a six-month prospective, single-center, observational study of mass effect stroke patients aged 18 to 65 years who had a traumatic brain injury (TBI) and were admitted to the ICU. Patients with chronic hydrocephalus, extensive local orbit trauma, a pre-existing ocular disease affecting the optic nerve and/or orbital cavity, hyperthyroidism with exophthalmos, and facial trauma affecting the orbits and/or eyeballs were excluded. We measured the ONSD at the entry of optic nerve into the globe using two-dimensional (2D) US. Results One hundred patients were included in the study. Forty-nine patients had diffuse cerebral edema detected on CT scan correlating with increased ONSD notable via bedside US. The mean ONSD related to CT-detectable elevated ICP was 0.61 cm. The sensitivity for the ONSD cut-off value of ≥5.8 mm was 94% (95% confidence interval [CI], 84.05% to 98.79%), and the specificity was 96.08% (95% CI, 86.7% to 99.52%).The positive predictive value was 92.08% (95% CI, 86.28% to 98.96%), and the negative predictive value was 94.23% (95% CI, 84.47% to 98.00%). Conclusion The greatest accuracy in ONSD was found with a cut-off of >0.58 cm in patients with positive CT brain findings. Therefore, US can be used as an initial screening test when physicians suspect a patient has elevated ICP. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/31058028/Optic_Nerve_Sheath_Diameter_Correlation_with_Elevated_Intracranial_Pressure_Determined_via_Ultrasound_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31058028/ DB - PRIME DP - Unbound Medicine ER -