Abstract
Background
Ultrasonography of the optic nerve sheath diameter (ONSD) is used for the non-invasive assessment of increased intracranial pressure (ICP). ONSD values are usually obtained by averaging the measurements of the two eyes, but asymmetric ONSD dilation is possible, leading to potentially inaccurate ICP estimation when using binocular averaging. In addition, few data are available about the asymmetry of the ONSD and the use of the maximum ONSD value between eyes for raised ICP detection. The aim of the study was to evaluate the interocular ONSD asymmetry in healthy subjects and patients with intracranial hypertension (IH) by ultrasonography and to investigate whether the maximum ONSD could be as useful as the binocular assessment.
Methods
Forty healthy subjects and 40 patients with IH (20 with idiopathic intracranial hypertension and 20 with intracerebral hemorrhage) who underwent transorbital sonography were retrospectively enrolled. The prevalence and degree of ONSD asymmetry were compared among groups; ONSD median binocular and maximum values were compared.
Results
Forty-two out of 80 subjects (52.5%) showed significant ONSD asymmetry, without significant differences in prevalence among groups (p = 0.28). The median asymmetry was higher in patients than in healthy subjects (0.45 mm vs 0.23 mm; p = 0.007), without significant differences between the two pathologies (p = 0.58). Both binocular and maximum ONSD measurements were significantly higher in patients with IH than in controls (p < 0.001).
Conclusions
Interocular ONSD asymmetry occurs both in healthy subjects and, more consistently, in patients with IH. Both binocular and maximum ONSD may be useful markers for increased ICP detection.
Similar content being viewed by others
References
Khan MN, Shallwani H, Khan MU, Shamim MS (2017 Apr 5) Noninvasive monitoring intracranial pressure – a review of available modalities. Surg Neurol Int 8:51. https://doi.org/10.4103/sni.sni_403_16
Sahu S, Swain A (2017) Optic nerve sheath diameter: a novel way to monitor the brain. J Neuroanaesthesiol Crit Care 4:S13–S18. https://doi.org/10.4103/jnacc.jnacc_73_16
Hayreh SS (2011) Structure of the Optic Nerve. In: Ischemic optic neuropathies. © Springer-Verlag, Berlin Heidelberg. https://doi.org/10.1007/978-3-642-11852-4_2
Hayreh SS (1984) The sheath of the optic nerve. Ophthalmologica. 189:54–63. https://doi.org/10.1159/000309386
Killer HE, Laeng HR, Flammer J, Groscurth P (2003) Architecture of arachnoid trabeculae, pillars, and septa in the subaranchnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol 87:777–781
Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, Taccone FS, Citerio G (2018 Aug) Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 44(8):1284–1294. https://doi.org/10.1007/s00134-018-5305-7
Lochner P, Czosnyka M, Naldi A, Lyros E, Pelosi P, Mathur S, Fassbender K, Robba C (2019) Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci. https://doi.org/10.1007/s10072-019-04015-x
Lochner P, Fassbender K, Leismeister M, Nardone R, Orioli A, Brigo F, Stolz E (2018) Ocular ultrasound for monitoring pseudotumor cerebri syndrome. J Neurol 265(2):356–361. https://doi.org/10.1007/s00415-017-8699-1
Naldi A, Pivetta E, Coppo L, Cantello R, Comi C, Stecco A, Cerrato P, Lesmeister M, Lochner P (2019 May) Ultrasonography monitoring of optic nerve sheath diameter and retinal vessels in patients with cerebral hemorrhage. J Neuroimaging 29(3):394–399. https://doi.org/10.1111/jon.12604
Friedmann DI, Liu GT, Digre KB (2013 Sep 24) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 81(13):1159–1165. https://doi.org/10.1212/WNL.0b013e3182a55f17
Lang EW, Ren Ya Z, Preul C, Hugo HH, Hempelmann RG, Buhl R, Barth H, Klinge H, Mehdorn HM (2001 Aug) Stroke pattern interpretation: the variability of hypertensive versus amyloid angiopathy haemorrhage. Cerebrovasc Dis 12(2):121–130
Ohle R, McIsaac SM, Woo MY, Perry JJ (2015) Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computer tomography: a systematic review and meta-analysis. J Ultrasound Med 34:1285–1294. https://doi.org/10.7863/ultra.34.7.1285
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27(8):1304–1305
Huttner HB, Steiner T, Hartmann M, Köhrmann M, Juettler E, Mueller S, Wikner J, Meyding-Lamade U, Schramm P, Schwab S, Schellinger PD (2006 Feb) Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke. 37(2):404–408
Ertl M, Barinka F, Torka E, Altmann M, Pfister K, Helbig H, Bogdahn U, Gamulescu MA, Schlachetzki F (2014 Oct) Ocular color-coded sonography – a promising tool for neurologists and intensive care physicians. Ultraschall Med 35(5):422–431. https://doi.org/10.1055/s-0034-1366113
R Core Team (2019) R: a language and environment for statistical computing. R Foundation for statistical computing, Vienna URL https://www.R-project.org
Hansen HC, Lagrèze W, Krueger O, Helmke K (2011 Sep) Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure – an experimental ultrasound study. Acta Ophthalmol 89(6):e528–e532. https://doi.org/10.1111/j.1755-3768.2011.02159.x
Bäuerle J, Niesen WD, Egger K, Buttler KJ, Reinhard M (2016 Mar-Apr) Enlarged optic nerve sheath in aneurysmal subarachnoid hemorrhage despite normal intracranial pressure. J Neuroimaging 26(2):194–196. https://doi.org/10.1111/jon.12287
Bidot S, Clough L, Saindane AM, Newman NJ, Biousse V, Bruce BB (2016 Jun) The optic canal size is associated with the severity of papilledema and poor visual function in idiopathic intracranial hypertension. J Neuroophthalmol 36(2):120–125. https://doi.org/10.1097/WNO.0000000000000318
Bidot S, Bruce BB, Saindane AM, Newman NJ, Biousse V (2015 Mar) Asymmetric papilledema in idiopathic intracranial hypertension. J Neuroophthalmol 35(1):31–36. https://doi.org/10.1097/WNO.0000000000000205
Hayreh SS (2016) Pathogenesis of optic disc edema in raised intracranial pressure. Prog Retin Eye Res 50:108–144. https://doi.org/10.1016/j.preteyeres.2015.10.001
Skoloudík D, Herzig R, Fadrná T, Bar M, Hradílek P, Roubec M, Jelínková M, Sanák D, Král M, Chmelová J, Herman M, Langová K, Kanovsky P (2011 Feb) Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage. Br J Ophthalmol 95(2):217–221. https://doi.org/10.1136/bjo.2009.172890
Young AM, Guilfovle MR, Donnelly J, Scoffings D, Fernandes H, Garnett M, Agrawal S, Hutchinson PJ (2017 Mar) Correlating optic nerve sheath diameter with opening intracranial pressure in pediatric traumatic brain injury. Pediatr Res 81(3):443–447. https://doi.org/10.1038/pr.2016.165
Tarzamni MK, Derakhshan B, Meshkini A, Merat H, Fouladi DF, Mostafazadeh S, Rezakhah A (2016) The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure. Clin Neurol Neurosurg 141:82–88. https://doi.org/10.1016/j.clineuro.2015.12.007
Agrawal A, Cheng R, Tang J, Madhok DY (2019 Jun) Comparison of two techniques to measure optic nerve sheath diameter at risk for increased intracranial pressure. Crit Care Med 47(6):e495–e501. https://doi.org/10.1097/CCM.0000000000003742
Acknowledgments
The authors thank the AGING Project – Department of Excellence – DIMET, Università del Piemonte Orientale, which contributed to the organization of the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Naldi, A., Provero, P., Vercelli, A. et al. Optic nerve sheath diameter asymmetry in healthy subjects and patients with intracranial hypertension. Neurol Sci 41, 329–333 (2020). https://doi.org/10.1007/s10072-019-04076-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-019-04076-y