1887
Volume 2022, Issue 2
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Bedside optic nerve sheath diameter (ONSD) measurement is increasingly being used to monitor raised intracranial pressure (ICP) in patients coming to an emergency department. This study aims to measure the accuracy of optic nerve sheath diameter (ONSD) measurement by ultrasound as a non-invasive method for early detection of raised intracranial pressure (ICP) in patients with non-traumatic emergencies presenting in emergency department settings, in comparison to CT/MRI brain scan findings of raised ICP. A total of 100 patients with non-traumatic emergencies suspected of raised ICP were seen in the emergency department. Bedside ONSD measurement was done within one hour of arrival. Patients underwent a CT/MRI brain scan within one hour of the ONSD in search of raised ICP. MS Excel spreadsheet was used for coding, SPSS v23 for data analysis, independent sample ‘t-test for group comparison, Wilcoxon test for non-normally distributed data, Chi-square test for group comparison for categorical data, Fischer's exact test for frequency <  5 and 25 % of the cells, Pearson's and Spearman's correlation for linear correlation and statistical significance were kept at p <  0.05. Using a cut-off ONSD value (mm) of 6.3 mm, this study found a sensitivity of 100%, specificity of 89.2%, PPV of 83.3%, NPV of 100%, and diagnostic accuracy of 93% for detection of raised ICP by bedside USG ONSD measurement compared to CT/MRI brain. The study shows that bedside ONSD measurement is a useful and acceptably reliable technique for detecting raised ICP of emergency department patients with non-traumatic emergencies and raised ICP.

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2022-01-24
2022-05-17
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References

  1. Dostovic Z, Dostovic E, Smajlovic D, Ibrahimagic OC, Avdic L. Brain Edema After Ischaemic Stroke. Med Arch (Sarajevo, Bosnia Herzegovina). 2016; 70:(5):339–341. doi:10.5455/medarh.2016.70.339-341 .
    [Google Scholar]
  2. Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR. Brain abscess: Current management. J Neurosci Rural Pract. 2013; 4:(Suppl 1):S67–S81. doi:10.4103/0976-3147.116472 .
    [Google Scholar]
  3. Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005; 41:(41):1179–1197. doi:10.1002/hep.20703 .
    [Google Scholar]
  4. CLARKE E, MURPHY EA. Neurological manifestations of malignant hypertension. Br Med J. 1956; 2:(2):1319–1326. doi:10.1136/bmj.2.5005.1319 .
    [Google Scholar]
  5. Levin DL. Cerebral edema in diabetic ketoacidosis. Pediatr Crit care Med a J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2008; 9:(9):320–329. doi:10.1097/PCC.0b013e31816c7082 .
    [Google Scholar]
  6. Stam J. Thrombosis of the Cerebral Veins and Sinuses. N Engl J Med. 2005; 352:(352):1791–1798. doi:10.1056/NEJMra042354 .
    [Google Scholar]
  7. Hoefnagel D, Dammers R, Ter Laak-Poort MP, Avezaat CJJ. Risk factors for infections related to external ventricular drainage. Acta Neurochir (Wien). 2008; 150:(150):209–214; discussion 214. doi:10.1007/s00701-007-1458-9 .
    [Google Scholar]
  8. Smith AM, Czyz CN. Neuroanatomy, Cranial Nerve 2 (Optic). In:; 2021..
    [Google Scholar]
  9. Komut E, Kozacı N, Sönmez BM, et al. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED. Am J Emerg Med. 2016; 34:(34):963–967. doi:10.1016/j.ajem.2016.02.012 .
    [Google Scholar]
  10. Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury. 2008; 39:(39):519–524. doi:10.1016/j.injury.2007.09.029 .
    [Google Scholar]
  11. Gupta S, Pachisia A. Ultrasound-measured optic nerve sheath diameter correlates well with cerebrospinal fluid pressure. Neurol India. 2019; 67:(67):772–776. doi:10.4103/0028-3886.263231 .
    [Google Scholar]
  12. Hayreh SS. Pathogenesis of optic disc edema in raised intracranial pressure. Prog Retin Eye Res. 2016;50:108–144. doi:10.1016/j.preteyeres.2015.10.001 .
    [Google Scholar]
  13. Hayreh SS. Pathogenesis of oedema of the optic disc. Doc Ophthalmol. 1968; 24:(24):289–411. doi:10.1007/BF02550944 .
    [Google Scholar]
  14. Geeraerts T, Launey Y, Martin L, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007; 33:(33):1704–1711. doi:10.1007/s00134-007-0797-6 .
    [Google Scholar]
  15. Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Crit Care. 2008; 12:(12):P117. doi:10.1186/cc6338 .
    [Google Scholar]
  16. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997; 87:(87):34–40. doi:10.3171/jns.1997.87.1.0034 .
    [Google Scholar]
  17. Messerer M, Berhouma M, Messerer R, Dubourg J. [Interest of optic nerve sheath diameter ultrasonography in detecting non-invasively raised intracranial pressure]. Neurochirurgie. 2013; 59:(59):55–59. doi:10.1016/j.neuchi.2013.02.001 .
    [Google Scholar]
  18. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011; 37:(37):1059–1068. doi:10.1007/s00134-011-2224-2 .
    [Google Scholar]
  19. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003; 10:(10):376–381. doi:10.1111/j.1553-2712.2003.tb01352.x .
    [Google Scholar]
  20. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008; 15:(15):201–204. doi:10.1111/j.1553-2712.2007.00031.x .
    [Google Scholar]
  21. Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol. 2009; 21:(21):16–20. doi:10.1097/ANA.0b013e318185996a .
    [Google Scholar]
  22. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients. Ann Emerg Med. 2007; 49:(49):508–514. doi:10.1016/j.annemergmed.2006.06.040 .
    [Google Scholar]
  23. Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009; 11:(11):406–410. doi:10.1007/s12028-009-9250-8 .
    [Google Scholar]
  24. Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008; 12:(3). doi:10.1186/cc6897 .
    [Google Scholar]
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