Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians
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Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians.
In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients.
ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension.
ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.
KeywordsOptic nerve sheath diameter (ONSD) Transorbital ultrasonography (TSO) Optic nerve Symptomatic intracranial hypotension (SIH) Intracranial pressure (ICP) Acute mountain sickness (AMS)
Compliance with ethical standards
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Geeraerts T, Launey Y, Martin L, Pottecher J, Vigue B, Duranteau J, Benhamou D (2007) Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 33:1704–1711. https://doi.org/10.1007/s00134-007-0797-6 CrossRefPubMedGoogle Scholar
- 16.Lochner P, Coppo L, Cantello R, Nardone R, Naldi A, Leone MA, Brigo F (2016) Intra- and interobserver reliability of transorbital sonographic assessment of the optic nerve sheath diameter and optic nerve diameter in healthy adults. J Ultrasound 19:41–45. https://doi.org/10.1007/s40477-014-0144-z CrossRefPubMedGoogle Scholar
- 18.Bauerle J, Schuchardt F, Schroeder L, Egger K, Weigel M, Harloff A (2013) Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol 13:187. https://doi.org/10.1186/1471-2377-13-187 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.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 49:508–514. https://doi.org/10.1016/j.annemergmed.2006.06.040 CrossRefPubMedGoogle Scholar
- 24.Chen LM, Wang LJ, Hu Y, Jiang XH, Wang YZ, Xing YQ (2019) Ultrasonic measurement of optic nerve sheath diameter: a non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure. Br J Ophthalmol 103:437–441. https://doi.org/10.1136/bjophthalmol-2018-312934 CrossRefPubMedGoogle Scholar
- 25.Ertl M, Aigner R, Krost M, Karnasova Z, Muller K, Naumann M, Schlachetzki F (2017) Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus: a useful diagnostic supplement to spinal tap tests. Eur J Neurol 24:461–467. https://doi.org/10.1111/ene.13225 CrossRefPubMedGoogle Scholar
- 28.Yesilaras M, Kilic TY, Yesilaras S, Atilla OD, Oncel D, Camlar M (2017) The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage. Am J Emerg Med 35:1408–1413. https://doi.org/10.1016/j.ajem.2017.04.022 CrossRefPubMedGoogle Scholar
- 35.Lochner P, Brigo F, Zedde ML, Sanguigni S, Coppo L, Nardone R, Naldi A, Sola D, Stolz E (2016) Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension. BMC Neurol 16:85. https://doi.org/10.1186/s12883-016-0594-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Sangani SV, Parikh S (2015) Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study. Indian J Radiol Imaging 25:173–176. https://doi.org/10.4103/0971-3026.155869 CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA Jr, Harris NS (2009) Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. J Appl Physiol 106:1207–1211. https://doi.org/10.1152/japplphysiol.01188.2007 CrossRefPubMedGoogle Scholar
- 55.Lee HC, Lee WJ, Dho YS, Cho WS, Kim YH, Park HP (2018) Optic nerve sheath diameter based on preoperative brain computed tomography and intracranial pressure are positively correlated in adults with hydrocephalus. Clin Neurol Neurosurg 167:31–35. https://doi.org/10.1016/j.clineuro.2018.02.012 CrossRefPubMedGoogle Scholar
- 67.Block HS, Biller J (2014) Neurology of pregnancy. Handb Clin Neurol 121:1595–1622. https://doi.org/10.1016/B978-0-7020-4088-7.00105-X CrossRefPubMedGoogle Scholar
- 68.Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S, Benhamou D, Mercier FJ, Geeraerts T (2012) Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study. Anesthesiology 116:1066–1071. https://doi.org/10.1097/ALN.0b013e318246ea1a CrossRefPubMedGoogle Scholar
- 72.Karvellas CJ, Fix OK, Battenhouse H, Durkalski V, Sanders C, Lee WM, Group USALFS (2014) Outcomes and complications of intracranial pressure monitoring in acute liver failure: a retrospective cohort study. Crit Care Med 42:1157–1167. https://doi.org/10.1097/CCM.0000000000000144 CrossRefPubMedPubMedCentralGoogle Scholar
- 77.Chelly J et al (2016) The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: a prospective pilot study. Resuscitation 103:7–13. https://doi.org/10.1016/j.resuscitation.2016.03.006 CrossRefPubMedGoogle Scholar
- 78.Chae MK et al (2016) Better prognostic value with combined optic nerve sheath diameter and grey-to-white matter ratio on initial brain computed tomography in post-cardiac arrest patients. Resuscitation 104:40–45. https://doi.org/10.1016/j.resuscitation.2016.04.001 CrossRefPubMedGoogle Scholar
- 81.You Y et al (2018) Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors. Resuscitation 131:42–47. https://doi.org/10.1016/j.resuscitation.2018.08.003 CrossRefPubMedGoogle Scholar
- 85.Kim MS, Bai SJ, Lee JR, Choi YD, Kim YJ, Choi SH (2014) Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol 28:801–806. https://doi.org/10.1089/end.2014.0019 CrossRefPubMedGoogle Scholar
- 87.Kim EJ, Koo BN, Choi SH, Park K, Kim MS (2018) Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure during laparoscopic surgery: a systematic review and meta-analysis. Surg Endosc 32:175–182. https://doi.org/10.1007/s00464-017-5653-3 CrossRefPubMedGoogle Scholar
- 88.Ertl M, Schierling W, Kasprzak P, Schomig B, Bruckl C, Schlachetzki F, Pfister K (2015) Optic nerve sheath diameter measurement to identify high-risk patients for spinal ischemia after endovascular thoracoabdominal aortic aneurysm repair. J Neuroimaging 25:910–915. https://doi.org/10.1111/jon.12234 CrossRefPubMedGoogle Scholar
- 89.Houze-Cerfon CH, Bounes V, Guemon J, Le Gourrierec T, Geeraerts T (2019) Quality and feasibility of sonographic measurement of the optic nerve sheath diameter to estimate the risk of raised intracranial pressure after traumatic brain injury in prehospital setting. Prehosp Emerg Care 23:277–283. https://doi.org/10.1080/10903127.2018.1501444 CrossRefPubMedGoogle Scholar
- 92.Gerber S et al (2017) Automatic estimation of the optic nerve sheath diameter from ultrasound images imaging for patient-customized simulations and systems for point-of-care ultrasound : International Workshops, BIVPCS 2017 and POCUS 2017, held in conjunction with MICCAI 2017, Quebec City, QC 10549:113–120 https://doi.org/10.1007/978-3-319-67552-7_14 CrossRefGoogle Scholar