Optic nerve sonography: A noninvasive means of detecting raised intracranial pressure in a resource-limited setting

Olufunso Simisola Aduayi, Christianah Mopelola Asaleye, Victor Adebayo Adetiloye, Edward Oluwole Komolafe, Victor Adovi Aduayi, Olufunso Simisola Aduayi, Christianah Mopelola Asaleye, Victor Adebayo Adetiloye, Edward Oluwole Komolafe, Victor Adovi Aduayi

Abstract

Objective: The aim was to assess the use of optic nerve sonography (ONS) as a quick, noninvasive diagnostic test tool for detecting raised the intracranial pressure (ICP).

Materials and methods: A prospective blinded observational study was conducted at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. The study population consisted of 160 adult patients referred to the radiology department for cranial computed tomography (CT) scan. There were 80 subjects and 80 controls. Optic nerve sheath diameter (ONSD) was measured by a radiologist using a 7.5 Megahertz ultrasound probe while cranial CT was reviewed by other radiologists blinded to the ONSD.

Results: Sixty-nine subjects (86.3%) had intracranial space occupying lesions (SOL) with cranial CT confirmed features of increased ICP, mean binocular ONSD of 5.7 ± 0.59 mm while 11 (13.7%) had intracranial SOL without any cranial CT evidence of increased ICP, mean binocular ONSD of 4.8 ± 0.39 mm. The difference of mean ONSD of the two groups was statistically significant (P = 0.0001). The controls had a mean binocular ONSD of 4.5 ± 0.22 mm and the difference in mean binocular ONSD for subjects with raised ICP and the controls were also statistically significant (P = 0.0001). A cut-off value of 5.2 mm (sensitivity 81.2% [95% confidence interval (CI): 69.9-89.6], specificity 100% [95% CI: 71.5-100]) was obtained from the receiver operator characteristics curve as the mean binocular ONSD that best predicts raised ICP confirmed by at least a sign on cranial CT.

Conclusions: Optic nerve sonography can differentiate between normal and elevated ICP and may serve as a useful screening tool in resource-limited practice.

Keywords: Optic nerve sheath diameter; raised intracranial pressure; resource-limited settings; ultrasound.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Axial ultrasound scan image of the left eye showing the hypoechoic optic nerve complex within the echogenic retrobulbar fat. Optic nerve sheath diameter measured at a point 3 mm behind the globe was 4.3 mm
Figure 2
Figure 2
Box plot shows the relationship between mean binocular optic nerve sheath diameter and presence or absence of raised intracranial pressure features on cranial computed tomography among subjects
Figure 3
Figure 3
Receiver operator characteristics curve the cut off value that maximizes sensitivity and specificity corresponds to 5.2 mm (sensitivity of 81.2% [95% confidence interval (CI): 69.9–89.6] and specificity of 100% [95% CI: 71.5–100]) area under curve = 0.90 (95% CI: 0.84–0.97)

References

    1. Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011;28:679–81.
    1. Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K. Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg. 2008;109:255–8.
    1. 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.
    1. Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Semiz M. The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J. 2007;24:251–4.
    1. Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009;11:406–10.
    1. Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A. Optic nerve sonography: A new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J. 2009;26:630–4.
    1. Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury. 2008;39:519–24.
    1. Karakitsos D, Soldatos T, Gouliamos A, Armaganidis A, Poularas J, Kalogeromitros A, et al. Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury. Transplant Proc. 2006;38:3700–6.
    1. Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008;12:R67.
    1. Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75:813–21.
    1. Malayeri AA, Bavarian S, Mehdizadeh M. Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med. 2005;24:143–7.
    1. Seestedt RC, Frankel MR. Intracerebral hemorrhage. Curr Treat Options Neurol. 1999;1:127–37.
    1. Lee LA, Sharar SR, Lam AM. Perioperative head injury management in the multiply injured trauma patient. Int Anesthesiol Clin. 2002;40:31–52.
    1. 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.
    1. Mateer J, Plummer D, Heller M, Olson D, Jehle D, Overton D, et al. Model curriculum for physician training in emergency ultrasonography. Ann Emerg Med. 1994;23:95–102.
    1. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201–4.
    1. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10:376–81.
    1. Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care. 2011;15:506–15.
    1. 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.
    1. Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007;33:1704–11.
    1. Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008;34:2062–7.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren