Reliability of Optic Nerve Ultrasound for the Evaluation of Patients with Spontaneous Intracranial Hemorrhage
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The aim of our study is to confirm the reliability of optic nerve ultrasound as a method to detect intracranial hypertension in patients with spontaneous intracranial hemorrhage, to assess the reproducibility of the measurement of the optic nerve sheath diameter (ONSD), and to verify that ONSD changes concurrently with intracranial pressure (ICP) variations.
Sixty-three adult patients with subarachnoid hemorrhage (n = 34) or primary intracerebral hemorrhage (n = 29) requiring sedation and invasive ICP monitoring were enrolled in a 10-bed multivalent ICU. ONSD was measured 3 mm behind the globe through a 7.5-MHz ultrasound probe. Mean binocular ONSD was used for statistical analysis. ICP values were registered simultaneously to ultrasonography. Twenty-eight ONSDs were measured consecutively by two different observers, and interobserver differences were calculated. Twelve coupled measurements were taken before and within 1 min after cerebrospinal fluid (CSF) drainage to control elevated ICP.
Ninety-four ONSD measurements were analyzed. 5.2 mm proved to be the optimal ONSD cut-off point to predict raised ICP (>20 mmHg) with 93.1% sensitivity (95% CI: 77.2–99%) and 73.85% specificity (95% CI: 61.5–84%). ONSD–ICP correlation coefficient was 0.7042 (95% CI for r = 0.5850–0.7936). The median interobserver ONSD difference was 0.25 mm. CSF drainage to control elevated ICP caused a rapid and significant reduction of ONSD (from 5.89 ± 0.61 to 5 ± 0.33 mm, P < 0.01).
Our investigation confirms the reliability of optic nerve ultrasound as a non-invasive method to detect elevated ICP in intracranial hemorrhage patients. ONSD measurements proved to have a good reproducibility. ONSD changes almost concurrently with CSF pressure variations.
- Hayreh SS. Pathogenesis of oedema of the optic disc (papilloedema). Br J Opthalmol. 1964;48:522–43. CrossRef
- Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Opthalmol. 1993;116:548–56.
- Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1996;26:701–5. CrossRef
- 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. CrossRef
- Helmke K, Burdelski M, Hansen H. Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation. 2000;70(2):392–5. CrossRef
- 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 Opthalmol. 2002;86:1109–13. CrossRef
- Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blavias 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. CrossRef
- Blavias M, Theodoro DL, Sierzenski P. Elevated intracranial pressure detected by bedside emergency ultrasound of the optic nerve sheath. Acad Emerg Med. 2003;10:376–81. CrossRef
- Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury. 2008;39(5):519–24. CrossRef
- 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;87:34–40. CrossRef
- Geeraerts T, Launey Y, Martin L, Kumar M, Gore MA. 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. CrossRef
- Harbison Kimberly H, Shah S, Marill K, Noble V. Correlation of optic nerve sheath with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201–4. CrossRef
- 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(11):2062–7. CrossRef
- Soldatos T, Karakistos 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):150. CrossRef
- Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients. J Neurosurg Anesthesiol. 2009;21(1):16–20. CrossRef
- Copetti R, Cattarossi L. Optic nerve ultrasound: artifacts and real images. Intensive Care Med [On-line] 2009. doi:10.1007/s00134-009-1494-4.
- Romagnulo L, Tayal V, Tomazewski C, Saunders T, Northon J. Optic nerve sheath does not change with patient position. Am J Emerg Med. 2005;23:686–8. CrossRef
- Lichtenstein D. Optic nerve and intracranial hypertension. In: Lichtenstein D, editor. General ultrasound in the critically ill. Berlin: Springer; 2007. p. 152–4.
- Geeraerts T, Bergès O, Merceron S, et al. Reply to Copetti and Cattarossi. Intensive Care Med [On-line] 2009. doi:10.1007/s00134-009-1495-3.
- Geeraerts T, Newcombe VFJ, Coles JP, Abate MJ, Perkes IE, Hutchinson PJA, et al. Use of T2-weighed magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care. 2008;12:R114. CrossRef
- Reliability of Optic Nerve Ultrasound for the Evaluation of Patients with Spontaneous Intracranial Hemorrhage
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- Optic nerve sheath diameter
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