Diagnostic Accuracy of Optic Nerve Ultrasonography and Ophthalmoscopy in Prediction of Elevated Intracranial Pressure

Keihan Golshani, Mehdi Ebrahim Zadeh, Ziba Farajzadegan, Fariborz Khorvash, Keihan Golshani, Mehdi Ebrahim Zadeh, Ziba Farajzadegan, Fariborz Khorvash

Abstract

Introduction: Elevated intracranial pressure (ICP) is a major and potentially lethal disorder in patients admitted to the emergency department (ED). Several methods are being used to investigate for elevated ICP. Here we assessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonography in detection of elevated ICP.

Methods: 131 participants with probable elevation of ICP referred to the emergency department of Al-Zahra Hospital, Isfahan, Iran, from 2012 to 2014, were enrolled. Brain computed tomography (CT) scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. The optic nerves sheath with diameter more than 5 millimeters was considered as elevated ICP. Widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tortuosity were recorded as evidences of ICP rising in ophthalmoscopy. Diagnostic accuracy of the two tools in prediction of ICP rising were compared with the results of brain CT scan as a gold standard.

Results: The mean age of participants was 46.29 ± 10 years (77% male). The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of ICP rising were 100.0% (95% CI: 88.6-100.0) and 35.4% (95% CI: 26.0-46.2), 100.0% (95% CI: 84.0-100.0) and 31.9% (95% CI: 23.0-41.7), respectively.

Conclusion: The present study revealed that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for the screening of patients with probable elevation of ICP. Of course, it should be considered that despite the high sensitivity of both tools, their specificity is low.

Keywords: Ultrasonography; diagnostic tests; ophthalmoscopy; optic disk; physical examination; routine.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) of ophthalmoscopy in detection of elevated intracranial pressure.
Figure 2
Figure 2
Receiver operating characteristic (ROC) of ultrasonography in detection of elevated intracranial pressure.

References

    1. Kalantari H, Jaiswal R, Bruck I, et al. Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med. 2013;31(11):1595–7.
    1. Arbour R. Intracranial hypertension monitoring and nursing assessment. Crit Care Nurse. 2004;24(5):19–32.
    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(4):508–14.
    1. Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75(6):813–21.
    1. Schaller B, Graf R. Different compartments of intracranial pressure and its relationship to cerebral blood flow. J Trauma. 2005;59(6):1521–31.
    1. Raboel P, Bartek J, Andresen M, Bellander B, Romner B. Intracranial pressure monitoring: invasive versus non-invasive methods—a review. Crit Care Res Pract. 2012;2012:1–4.
    1. Rothwell P, Gibson R, Sellar R. Computed tomographic evidence of cerebral swelling in benign intracranial hypertension. J Neurol Neurosurg Psychiatry. 1994;57(11):1407–9.
    1. Kimberly HH, Noble VE. Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care. 2008;12(5):181.
    1. Mizrachi IB-B, Trobe JD, Gebarski SS, Garton HJ. Papilledema in the assessment of ventriculomegaly. J Neuroophthalmol. 2006;26(4):260–3.
    1. Malayeri AA, Bavarian S, Mehdizadeh M. Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med. 2005;24(2):143–7.
    1. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37(7):1059–68.
    1. Amini A, Eghtesadi R, Feizi AM, et al. Sonographic Optic Nerve Sheath Diameter as a Screening Tool for Detection of Elevated Intracranial Pressure. Emergency. 2013;1(1):15–9.
    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(2):201–4.
    1. Hergenroeder GW, Moore AN, McCoy JP, et al. Serum IL-6: a candidate biomarker for intracranial pressure elevation following isolated traumatic brain injury. J Neuroinflammation. 2010;7(1):19.
    1. Motschmann M, Müller C, Kuchenbecker J, et al. Ophthalmodynamometry: a reliable method for measuring intracranial pressure. Strabismus. 2001;9(1):13–6.
    1. Amini A, Kariman H, Arhami Dolatabadi A, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med. 2013;31(1):236–9.
    1. Caffery TS, Perret JN, Musso MW, Jones GN. Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure. Am J Emerg Med. [In press]
    1. Rajajee V, Vanaman M, Fletcher J, Jacobs T. Optic Nerve Ultrasound for the Detection of Raised Intracranial Pressure. Neurocrit Care. 2011;15(3):506–15.
    1. Mena OJ, Paul I, Reichard RR. Ocular Findings in Raised Intracranial Pressure: A Case of Terson Syndrome in a 7-Month-Old Infant. Am J Forensic Med Pathol. 2011;32(1):55–7.

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