Main Article Content
Abstract
BACKGROUND
Several studies have found an association between raised intracranial pressure (ICP) and optic nerve sheath diameter (ONSD) in conditions with severe head injury and intracranial bleeding. Idiopathic intracranial hypertension is also a cause of elevated ICP. Because the meninges and subarachnoid space around the optic nerve are continuous, a rise in ICP can be detected with an increase in ONSD. The objectives of this study were to correlate Optic Nerve Sheath Diameter (ONSD) with features suggestive of raised intracranial pressure on CT / MRI of the Brain and describe the features suggestive of raised intracranial pressure on CT/MRI Brain in clinically suspected patients.
METHODS
This was a case control study carried out in the Department of Radio-diagnosis at MGMCRI for suspected raised intracranial pressure evaluation. All these patients were subjected to ultrasound examination of the eye and the optic sheath diameter was measured while the patients were in supine posture. ONSD was measured on Mind ray DC8, and/or GE S7 Expert using High frequency linear probe on the closed upper eyelid with adequate aqueous gel as a coupling agent. ONSD was also measured in Philips 1.5T MRI and Ge optima 128 slice CT. Patients were followed up on whether they were treated surgically or medically and if they developed clinical signs of raised ICP such as headache, vomiting, raised blood pressure, double vision, confusion or loss of consciousness.
RESULTS
The raised ICP was observed in 30.67 % of study patients and the optic nerve sheath distension was observed in 37.33% of patients. The diagnostic accuracy of determining the optic nerve sheath diameter was equal such as area under curve, sensitivity and specificity as 0.833, 66.67% and 100 % respectively in both methods.
CONCLUSIONS
ONSD has emerged as an interesting option for measuring intracranial hypertension in brain-injured states, owing to its simplicity, non-invasive nature, and accessibility.
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References
- O'Reilly MW, Westgate CS, Hornby C, et al. A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics. JCI Insight 2019;4(6):e125348.
- Gjerris F, Brennum J. The cerebrospinal fluid, intracranial pressure and herniation of the brain. In: Paulson OB, Gjerris F, Sørensen PS, eds. Clinical neurology and neurosurgery. Copenhagen, Denmark: FADL’s Forlag Aktieselskab 2004:179-96.
- Talving P, Karamanos E, Teixeira PG, et al. Intracranial pressure monitoring in severe head injury: compliance with brain trauma foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 2013;119(5):1248-54.
- Bullock R, Chesnut RM, Clifton G, et al. Guidelines for the management of severe head injury. Brain trauma foundation. Eur J Emerg Med 1996;3(2):109-27.
- Tuite GF, Chong WK, Evanson J, et al. The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery 1996;38(2):272-8.
- Killer HE, Jaggi GP, Flammer J, et al. Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain 2007;130(Pt 2):514-20.
- Gangemi M, Cennamo G, Maiuri F, et al. Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987;30(2):53-5.
- Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg 1997;87(1):34-40.
- Raj G, Singh R, Deodhar M, et al. B-scan measurement of optic nerve sheath diameter as a marker of elevated intracranial pressure. Int J Res Med Sci 2017;5(6):2397-400.
- Munta K, Shirodkar CG, Rao SM, et al. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian Journal of Critical Care Medicine 2015;19(8):466-70.
- Sekhon MS, McBeth P, Zou J, et al. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care 2014;21(2):245-52.
- Hossain F, Karim MN, Rahman SMM, et al. Preoperative detection of ovarian cancer by color Doppler ultrasonography and CA 125. Bangladesh Med Res Counc Bull 2010;36(2):68-73.
- Wang J, Li K, Li H, et al. Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg 2019:1-7.
- Vaiman M, Abuita R, Bekerman I. Optic nerve sheath diameters in healthy adults measured by computer tomography. Int J Ophthalmol 2015;8(6):1240 4.
- Sekhon MS, Griesdale DE, Robba C, et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med 2014;40(9):1267 74.
- Dubourg J, Javouhey E, Geeraerts T, et al. 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.
References
O'Reilly MW, Westgate CS, Hornby C, et al. A unique androgen excess signature in idiopathic intracranial hypertension is linked to cerebrospinal fluid dynamics. JCI Insight 2019;4(6):e125348.
Gjerris F, Brennum J. The cerebrospinal fluid, intracranial pressure and herniation of the brain. In: Paulson OB, Gjerris F, Sørensen PS, eds. Clinical neurology and neurosurgery. Copenhagen, Denmark: FADL’s Forlag Aktieselskab 2004:179-96.
Talving P, Karamanos E, Teixeira PG, et al. Intracranial pressure monitoring in severe head injury: compliance with brain trauma foundation guidelines and effect on outcomes: a prospective study. J Neurosurg 2013;119(5):1248-54.
Bullock R, Chesnut RM, Clifton G, et al. Guidelines for the management of severe head injury. Brain trauma foundation. Eur J Emerg Med 1996;3(2):109-27.
Tuite GF, Chong WK, Evanson J, et al. The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery 1996;38(2):272-8.
Killer HE, Jaggi GP, Flammer J, et al. Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain 2007;130(Pt 2):514-20.
Gangemi M, Cennamo G, Maiuri F, et al. Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987;30(2):53-5.
Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg 1997;87(1):34-40.
Raj G, Singh R, Deodhar M, et al. B-scan measurement of optic nerve sheath diameter as a marker of elevated intracranial pressure. Int J Res Med Sci 2017;5(6):2397-400.
Munta K, Shirodkar CG, Rao SM, et al. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian Journal of Critical Care Medicine 2015;19(8):466-70.
Sekhon MS, McBeth P, Zou J, et al. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care 2014;21(2):245-52.
Hossain F, Karim MN, Rahman SMM, et al. Preoperative detection of ovarian cancer by color Doppler ultrasonography and CA 125. Bangladesh Med Res Counc Bull 2010;36(2):68-73.
Wang J, Li K, Li H, et al. Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg 2019:1-7.
Vaiman M, Abuita R, Bekerman I. Optic nerve sheath diameters in healthy adults measured by computer tomography. Int J Ophthalmol 2015;8(6):1240 4.
Sekhon MS, Griesdale DE, Robba C, et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med 2014;40(9):1267 74.
Dubourg J, Javouhey E, Geeraerts T, et al. 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.