Optic Nerve Sheath Diameter Ultrasound and the Diagnosis of Increased Intracranial Pressure

2016 ◽  
Vol 28 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Christopher Hylkema
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Increased Intracranial Pressure ◽  
Nerve Sheath

Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: a meta-analysis

2018 ◽  
Vol 60 (2) ◽  
pp. 221-229 ◽  
Author(s):  
Sung-Eun Kim ◽  
Eun Pyo Hong ◽  
Heung Cheol Kim ◽  
Si Un Lee ◽  
Jin Pyeong Jeon
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Meta Analysis ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Increased Intracranial Pressure ◽  
Summary Receiver Operating Characteristic ◽  
Nerve Sheath ◽  
Study Characteristics ◽  
Meta Regression

Background The optimal optic nerve sheath diameter (ONSD) cut-off for identifying increased intracranial pressure (IICP) remains unclear in adult patients. Purpose To validate the diagnostic accuracy of ultrasonographic (US) ONSD > 5.0 mm as a cut-off for detecting IICP by computed tomographic (CT) through a meta-analysis. Material and Methods A systemic literature review was performed of online databases from January 1990 to September 2017. A bivariate random-effects model was used to estimate pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs). A summary receiver operating characteristic (SROC) graph was used to provide summary points for sensitivity and specificity. Meta-regression tests were performed to estimate the influence of the study characteristics on DOR. Publication bias was assessed using Deeks' funnel plot asymmetry test. Results Six studies with 352 patients were included in the meta-analysis. US ONSD > 5.0 mm revealed pooled sensitivity of 99% (95% CI = 96–100) and specificity of 73% (95% CI = 65–80) for IICP detection. DOR was 178. The area under the SROC curve was 0.981, indicating a good level of accuracy. Meta-regression studies showed no significant associations between DOR and study characteristics such as probe mode (relative DOR [RDOR] = 0.60; P = 0.78), study quality (RDOR = 0.52; P = 0.67), IICP prevalence (RDOR = 0.04; P = 0.17), or pathology at admission (RDOR = 1.30; P = 0.87). Conclusion US ONSD > 5.0 mm can be used to rapidly detect IICP in adults in emergency departments and intensive care units. Further meta-analysis based on individual patient-level databases is needed to confirm these results.

scholarly journals Accuracy of Noninvasive Intraocular Pressure or Optic Nerve Sheath Diameter Measurements for Predicting Elevated Intracranial Pressure in Cryptococcal Meningitis

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Henry W. Nabeta ◽  
Nathan C. Bahr ◽  
Joshua Rhein ◽  
Nicholas Fossland ◽  
Agnes N. Kiragga ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Cryptococcal Meningitis ◽  
Optic Nerve Sheath Diameter ◽  
Diagnostic Value ◽  
Optic Nerve Sheath ◽  
Increased Intracranial Pressure ◽  
Nerve Sheath ◽  
Immunodeficiency Virus

Abstract Background.  Cryptococcal meningitis is associated with increased intracranial pressure (ICP). Therapeutic lumbar puncture (LP) is recommended when the initial ICP is >250 mm H2O, yet the availability of manometers in Africa is limited and not always used where available. We assessed whether intraocular pressure could be a noninvasive surrogate predictor to determine when additional therapeutic LPs are necessary. Methods.  Ninety-eight human immunodeficiency virus-infected Ugandans with suspected meningitis (81% Cryptococcus) had intraocular pressure measured using a handheld tonometer (n = 78) or optic nerve sheath diameter (ONSD) measured by ultrasound (n = 81). We determined the diagnostic performance of these methods for predicting ICP vs a standard manometer. Results.  The median ICP was 225 mm H2O (interquartile range [IQR], 135–405 mm H2O). The median intraocular pressure was 28 mm Hg (IQR, 22–37 mm Hg), and median ultrasound ONSD was 5.4 mm (IQR, 4.95–6.1 mm). ICP moderately correlated with intraocular pressure (ρ = 0.45, P < .001) and with ultrasound ONSD (ρ = 0.44, P < .001). There were not discrete threshold cutoff values for either tonometry or ultrasound ONSD that provided a suitable cutoff diagnostic value to predict elevated ICP (>200 mm H2O). However, risk of elevated ICP >200 mm H2O was increased with an average intraocular pressure >28 mm Hg (relative risk [RR] = 3.03; 95% confidence interval [CI], 1.55–5.92; P < .001) or an average of ONSD >5 mm (RR = 2.39; 95% CI, 1.42–4.03; P = .003). As either intraocular pressure or ONSD increased, probability of elevated ICP increased (ie, positive predictive value increased). Conclusions.  Noninvasive intraocular pressure measurements by tonometry or ultrasound correlate with cerebrospinal fluid opening pressure, but both are a suboptimal replacement for actual ICP measurement with a manometer.

scholarly journals Measurement of Optic Nerve Sheath Diameter to Detect Increased Intracranial Pressure in Hypertensive Patients

2020 ◽  
Vol 19 (1) ◽  
pp. 40-45
Author(s):  
Cesareddin Dikmetaş ◽  
Mehmet Ergin ◽  
Çiğdem Savaş Duman ◽  
Mustafa Gülpembe ◽  
Tarık Acar ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Increased Intracranial Pressure ◽  
Hypertensive Patients ◽  
Nerve Sheath
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