Pediatric Radiology

, Volume 26, Issue 10, pp 706–710 | Cite as

Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension

II. Patient study
  • K. Helmke
  • H. C. Hansen


Up to now, the presence of elevated intracranial pressure (ICP) in acute neurological disorders is suspected by clinical and neuroimaging findings, but its verification depends on invasive techniques. Based on our experimental findings of rapid dilatation of human optic nerve sheaths (ONS), we investigated whether this phenomenon not only happens under chronic, but also under acute conditions of intracranial hypertension. Using optic nerve sonography the ONS was measured at 3 mm behind the papilla in axial transbulbar view. Thirty-nine children admitted to the intensive care unit (ICU) were examined. Of these 24 were being treated for elevated ICP (head trauma, metabolic disorder) and were compared to control patients (outpatients). The ONS diameter (ONSD) found in ICU patients with elevated ICP ranged up to 6.8 mm and was significantly enlarged compared with normal data (Wilcoxon's test,P − 0.007). The ONSD of ICU patients without pressure elevation was in the same range as that of control patients (2.7–4.0 mm). Considering the error of measurement (0.35 mm), the ONSD is regarded as definitely enlarged when 5 mm is exceeded in children above age 4. In younger children, smaller ONSD have to be taken into consideration. We conclude that ultrasound studies of the optic nerve may contribute information about the acutely increased ICP in critically ill patients.


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  1. 1.
    Lundberg N (1960) Commons recording and control of ventricular pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36: 1–193Google Scholar
  2. 2.
    Sundbärg G, Nordström CH, Söderström S (1989) Complications due to prolonged ventricular fluid pressure recording. Br J Neurosurg 2: 485–495Google Scholar
  3. 3.
    Gaab MR, Sörensen N, Brawanski A, Bushe KA, Wodarz R (1980) Non-invasive intracranial pressure monitoring by fontanometry. Z Kinderchir 31: 339–347Google Scholar
  4. 4.
    Blomelburg T, Koch HG (1990) Transkranielles Doppler-Sonographisches Langzeitmonitoring bei erhöhtem Hirndruck infolge contusio cerebri. Monatsschr Kinderheilkd 138: 680–683PubMedGoogle Scholar
  5. 5.
    Goodwin SR, Friedman WA, Bellefleur M (1991) Is it time to use evoked potentials to predict outcome in comatose children and adults? Crit Care Med 4: 518–524Google Scholar
  6. 6.
    Harwood-Nash DC, Fitz CR, Reilly BS (1975) Cranial computed tomography in infants and children. Can Med Assoc J 113:546–549PubMedGoogle Scholar
  7. 7.
    Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47: 503–516PubMedGoogle Scholar
  8. 8.
    Plum F, Posner JB (1982) The diagnosis of stupor and coma, 3rd edn. Davis, PhiladelphiaGoogle Scholar
  9. 9.
    Guthoff R, Triebel G, Schröder W, Onken C, Abramo F (1990) Evaluation of the subarachnoidal space — comparisons between ultrasound and high resolution NMR techniques. In: Sampolesi R (ed) Ultrasonography in ophthalmology, vol 12. Kluwer, Dordrecht, pp 55–62Google Scholar
  10. 10.
    Schröder W (1976) Ergebnisse der A-Bildechographic bei einseitigen Sehnerverkrankungen. Klin Monatsbi Augenheilkd 169: 30–38Google Scholar
  11. 11.
    Ossoinig KC (1993) Standardized echography of the optic nerve. In: Till P (ed) Ophthalmic echography, vol 13. Kluwer Academic, Dordrecht, pp 3–99Google Scholar
  12. 12.
    Szabo A, Pelle Z, Nemeth J, Janaky M (1993) Optic nerve anomalies in childhood. In: Till P (ed) Ophthalmic echography 13 (Doc Ophthalmol Proc Series, vol 55). Kluwer, Dordrecht, pp 123–125Google Scholar
  13. 13.
    Harwood-Nash DC (1972) Paediatric neuroradiology. Radiol Clin North Am 10: 313–331PubMedGoogle Scholar
  14. 14.
    Lorke DE, Lauer M (1990) Gliogenesis and myelination in the optic nerve of trisomy 19 mice. Acta Anat (Basel) 137:222–233Google Scholar
  15. 15.
    Hansen HC, Helmke K, Kunze K (1994) Optic nerve sheath enlargement in acute intracranial hypertension. Neuroophthalmology 14: 345–354Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • K. Helmke
    • 1
  • H. C. Hansen
    • 2
  1. 1.Department of Pediatric RadiologyUniversity Hospital Eppendorf, University of HamburgHamburgGermany
  2. 2.Department of NeurologyUniversity Hospital EppendorfHamburgGermany

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