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Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Neurology, Saarland University Medical Center, Homburg, Germany

    Piergiorgio Lochner, Epameinondas Lyros, Shrey Mathur & Klaus Fassbender

  2. Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK

    Marek Czosnyka

  3. Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy

    Andrea Naldi

  4. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy

    Paolo Pelosi & Chiara Robba

  5. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy

    Paolo Pelosi

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  1. Piergiorgio Lochner
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  2. Marek Czosnyka
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Correspondence to Piergiorgio Lochner.

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Lochner, P., Czosnyka, M., Naldi, A. et al. Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci 40, 2447–2457 (2019). https://doi.org/10.1007/s10072-019-04015-x

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