Intensive Care Medicine

, Volume 33, Issue 10, pp 1704–1711 | Cite as

Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury

  • Thomas GeeraertsEmail author
  • Yoann Launey
  • Laurent Martin
  • Julien Pottecher
  • Bernard Vigué
  • Jacques Duranteau
  • Dan Benhamou



To assess at admission to the ICU the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) and to investigate whether increased ONSD at patient admission is associated with raised ICP in the first 48 h after trauma.

Design and setting

Prospective, blind, observational study in a surgical critical care unit, level 1 trauma center.

Patients and participants

31 adult patients with severe traumatic brain injury (TBI; Glasgow coma scale ≤ 8) requiring sedation and ICP monitoring, and 31 control patients without brain injury requiring sedation.

Measurements and results

ONSD was measured with a 7.5-MHz linear ultrasound probe. Two TBI groups were defined on the basis of ICP profile. If ICP exceeded 20 mmHg for more than 30 min in the first 48 h (before any specific treatment), patients were considered to have high ICP; if not, they had normal ICP. The largest ONSD value (the highest value for the right and left eye) was significantly higher in high ICP patients (6.3 ± 0.6 vs. 5.1 ± 0.7 mm in normal ICP patients and 4.9 ± 0.3 mm in control patients). There was a significant relationship between the largest ONSD and ICP at admission (r = 0.68). The largest ONSD was a suitable predictor of high ICP (area under ROC curve 0.96). When ONSD was under 5.7 mm, the sensitivity and negative predictive values for high ICP were 100%.


In the early posttraumatic period, ocular ultrasound scans may be useful for detecting high ICP after severe TBI.


Ocular ultrasound Traumatic brain injury Elevated intracranial pressure Optic nerve sheath 



The authors thank Mr. Philippe Payet for drawing the illustration presented on the left part of Fig. 1.

Supplementary material

134_2007_797_MOESM1_ESM.doc (26 kb)
Electronic Supplementary Material (DOC 32K)
134_2007_797_MOESM2_ESM.doc (30 kb)
Electronic Supplementary Material (DOC 30K)


  1. 1.
    Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502PubMedGoogle Scholar
  2. 2.
    Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. II. Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50:26–30PubMedGoogle Scholar
  3. 3.
    Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216–222PubMedGoogle Scholar
  4. 4.
    Ghajar J (2000) Traumatic brain injury. Lancet 356:923–929PubMedCrossRefGoogle Scholar
  5. 5.
    Hassler W, Steinmetz H, Gawlowski J (1988) Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 68:745–751PubMedGoogle Scholar
  6. 6.
    Aaslid R, Huber P, Nornes H (1986) A transcranial Doppler method in the evaluation of cerebrovascular spasm. Neuroradiology 28:11–16PubMedCrossRefGoogle Scholar
  7. 7.
    Kirkpatrick PJ, Chan KH (1997) Transcranial Doppler. In: Reilly P, Bullock R (eds) Head injury. Chapman & Hall, LondonGoogle Scholar
  8. 8.
    Liu D, Kahn M (1993) Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol 116:548–556PubMedGoogle Scholar
  9. 9.
    Villain MA, Candon E, Arnaud B, Hamard H, Adenis JP (2003) Optic nerve sheath decompression in optic neuropathy complicating idiopathic intracranial hypertension: a new focus. J Fr Ophtalmol 26:191–197PubMedGoogle Scholar
  10. 10.
    Hayreh SS (1968) Pathogenesis of oedema of the optic disc. Doc Ophthalmol 24:289–411PubMedCrossRefGoogle Scholar
  11. 11.
    Lichtenstein D (1992) In: Lichtenstein D (eds) L'echographie générale en réanimation. Springer, Berlin Heidelberg New YorkGoogle Scholar
  12. 12.
    Hansen HC, Helmke K (1996) The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 18:323–328PubMedCrossRefGoogle Scholar
  13. 13.
    Hansen HC, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87:34–40PubMedGoogle Scholar
  14. 14.
    Newman WD, Hollman AS, Dutton GN, Carachi R (2002) Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86:1109–1113PubMedCrossRefGoogle Scholar
  15. 15.
    Blaivas M, Theodoro D, Sierzenski PR (2003) Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 10:376–381PubMedCrossRefGoogle Scholar
  16. 16.
    Helmke K, Burdelski M, Hansen HC (2000) Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation 70:392–395PubMedCrossRefGoogle Scholar
  17. 17.
    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M (2007) Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49:508–514PubMedCrossRefGoogle Scholar
  18. 18.
    Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26:701–705PubMedCrossRefGoogle Scholar
  19. 19.
    Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. II. Patient study. Pediatr Radiol 26:706–710PubMedCrossRefGoogle Scholar
  20. 20.
    Blaivas M, Theodoro D, Sierzenski PR (2002) A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med 9:791–799PubMedCrossRefGoogle Scholar
  21. 21.
    Steiner LA, Andrews PJ (2006) Monitoring the injured brain: ICP and CBF. Br J Anaesth 97:26–38PubMedCrossRefGoogle Scholar
  22. 22.
    Jaffres P, Brun J, Declety P, Bosson JL, Fauvage B, Schleiermacher A, Kaddour A, Anglade D, Jacquot C, Payen JF (2005) Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma. Intensive Care Med 31:785–790PubMedCrossRefGoogle Scholar
  23. 23.
    Ract C, Le Moigno S, Bruder N, Vigue B (2007) Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med 33:645–651PubMedCrossRefGoogle Scholar
  24. 24.
    Barnett SB, Ter Haar GR, Ziskin MC, Rott HD, Duck FA, Maeda K (2000) International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine. Ultrasound Med Biol 26:355–366PubMedCrossRefGoogle Scholar
  25. 25.
    Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma [Suppl] 9(1):S287–S292Google Scholar
  26. 26.
    Eisenberg HM, Gary HE Jr, Aldrich EF, Saydjari C, Turner B, Foulkes MA, Jane JA, Marmarou A, Marshall LF, Young HF (1990) Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73:688–698PubMedGoogle Scholar
  27. 27.
    Lobato RD, Sarabia R, Rivas JJ, Cordobes F, Castro S, Munoz MJ, Cabrera A, Barcena A, Lamas E (1986) Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65:784–789PubMedGoogle Scholar
  28. 28.
    Stein SC, Spettell C, Young G, Ross SE (1993) Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32:25–30PubMedCrossRefGoogle Scholar
  29. 29.
    Holt GR, Holt JE (1983) Incidence of eye injuries in facial fractures: an analysis of 727 cases. Otolaryngol Head Neck Surg 91:276–279PubMedGoogle Scholar
  30. 30.
    Williamson TH, Harris A (1996) Color Doppler ultrasound imaging of the eye and orbit. Surv Ophthalmol 40:255–267PubMedCrossRefGoogle Scholar
  31. 31.
    Ballantyne SA, O'Neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15:145–149PubMedCrossRefGoogle Scholar
  32. 32.
    Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, Kalkman CJ (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33:2207–2213PubMedCrossRefGoogle Scholar
  33. 33.
    Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care (2000) Recommendations for intracranial pressure monitoring technology. J Neurotrauma 17:497–506CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Thomas Geeraerts
    • 1
    Email author
  • Yoann Launey
    • 1
  • Laurent Martin
    • 1
  • Julien Pottecher
    • 1
  • Bernard Vigué
    • 1
  • Jacques Duranteau
    • 1
  • Dan Benhamou
    • 1
  1. 1.Department of Anesthesiology and Critical Care Medicine, Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculty of MedicineUniversity of Paris-SudParisFrance

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