ULTRASONOGRAPHIC OPTIC NERVE SHEATH DIAMETER MEASUREMENT FOR RAISED INTRACRANIAL PRESSURE IN A TERTIARY CARE CENTRE OF A DEVELOPING COUNTRY
Abstract
Background: Intracranial hypertension is not an uncommon life-threatening syndrome, caused by a variety of non-neurological and neurological illnesses, and quick diagnosis, timely treatment of Raised Intracranial Pressure (ICP) is associated with improved outcome. Our aim of study was to determine ultrasonographic measurement of Optic nerve sheath diameter (ONSD) for raised ICP. Methods: Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital. ONSD measurement in millimetres was done by placing linear probe of ultrasound on eye ball. Results: Forty-eight patients were included in study with mean age of 7.5±5.0 years with 21/48 (43.8%) between 1-8 years and 19/48 (39.6%) >8 years with 32/48 (66.7%) were male. Non-traumatic coma was most common diagnosis 41/48 (85.4%) with infectious cause being most common while Traumatic brain injury constitutes 7/48 (14.6%). Ct scan brain was done in 39/48 (81.3%) while MRI brain in rest of patients. Raised ICP was found in 83.33% (40/48) patients with Ultrasonographic ONSD measurement as compared to CT scan/MRI 14/48 (29.2%). 85% of patients, showed ultrasonographic ONSD measurement suggestive of Raised ICP with GCS ‰¤12. Mean ONSD with signs of raised ICP in infants 4.64 (±0.48), in 1-10 years 6.44 (±0.65), and in adolescent >10 years 6.28 (±0.62) ONSD respectively with ROC Curve showing Area Under Curve (AUC) 0.814 ( 95% CI, 0.692-0.936). Conclusion: We identified threshold of Ultrasonographic ONSD measurement in infants >4.0 mm, in children 1-10 yrs >4.71 mm, in adolescent >10 yrs >5.43 mm for raised ICP with sensitivity and specificity of 100% and 60-66.7% respectively. 85% of patients showed raised ICP with Ultrasonographic ONSD measurement with GCS ‰¤12.
Keywords: Ultrasonography, Optic nerve sheath diameter, Raised Intracranial Pressure, Paediatric intensive care unitReferences
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.
Guillaume J, Janny P. [Continuous intracranial manometry; physiopathologic and clinical significance of the method]. Presse Med 1951;59(45):953-5.
Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 1960;36(149):1-193.
Rickert K, Sinson G. Intracranial pressure monitoring. Oper Tech Gen Surg 2003;5(3):170-5.
The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Recommendations for intracranial pressure monitoring technology. J Neurotrauma 2000;17(6-7):497-506.
Wilberger JE Jr. Outcomes analysis: intracranial pressure monitoring. Clin Neurosurg 1997;44:439-48.
Winkler F, Kastenbauer S, Yousry TA, Maerz U, Pfister HW. Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis. J Neurol 2002;249(9):1292-7.
Hiler M, Czosnyka M, Hutchinson P, Balestreri M, Smielewski P, Matta B, et al. Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury. J Neurosurg 2006;104(5):731-7.
Rosenberg JB, Shiloh AL, Savel RH, Eisen LA. Non-invasive methods of estimating intracranial pressure. Neurocrit Care 2011;15(3):599-608.
Qayyum H, Ramlakhan S. Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department. Eur J Emerg Med 2013;20(2):91-7.
Geeraerts T, Newcombe VF, Coles JP, Abate MG, Perkes IE, Hutchinson PJ, et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 2008;12(5):R114.
Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 2002;86(10):1109-13.
Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 1996;26(10):701-5.
Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med 2009;53(6):785-91.
Beare NA, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, et al. Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop Med Int Health 2008;13(11):1400-4.
Maude RR, Hossain MA, Hassan MU, Osbourne S, Sayeed KL, Karim MR, et al. Transorbital sonographic evaluation of normal optic nerve sheath diameter in healthy volunteers in Bangladesh. PloS One 2013;8(12):e81013.
Korber F, Scharf M, Moritz J, Dralle D, Alzen G. [Sonography of the optical nerve -- experience in 483 children]. RoFo 2005;177(2):229-35.
Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, et al. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol 1999;54(11):740-2.
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol 2008;56(1):45-50.
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.
Hansen H, Helmeke K, Kunze K. Optic Nerve Sheath Enlargement in Acute Intracranial Hypertension. Neuro Ophthalmol 1994;14(6):345-54.
Ballantyne SA, O'Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 2002;15(3):145-9.
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(3):R67.
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigue 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(10):1704-11.
Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008;34(11):2062-7.
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.
Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol 2009;21(1):16-20.
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(3):406-10.
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