Figure - available from: Case Reports in Emergency Medicine
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Bedside ocular ultrasound of the patient’s left eye demonstrating optic nerve sheath diameter (ONSD) measurement. The measurement of the ONSD is taken 3 mm posterior to the globe and occurs perpendicular to the long axis of the optic nerve.
Source publication
Bedside sonographic measurement of optic nerve sheath diameter can aid in the diagnosis of elevated intracranial pressure in the emergency department. This case report describes a 21-year-old female presenting with 4 months of mild headache and 2 weeks of recurrent, transient binocular vision loss. Though limited by patient discomfort, fundoscopic...
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Purpose
Measurement of optic nerve sheath diameter (ONSD) with ocular ultrasonography (USG) is a noninvasive technique that can be readily used to determine clues of increased intracranial pressure. In this study, we aimed to determine the role of optic nerve sheath diameter measurements in the diagnosis and follow-up of pediatric patients with idi...
Citations
... Elevated or bulged optic nerve cup has been described as an ultrasound sign of papilledema [23]. Hayreh [24] described optic disc edema to be a mechanical phenomenon following raised ICP. ...
Introduction:
Role of CT scan, MRI, ophthalmoscopy, direct monitoring by a transducer probe in identifying raised intracranial pressure (ICP) in emergency department (ED) is limited. There are few studies correlating elevated optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS) with raised ICP in pediatrics emergencies. We studied the diagnostic accuracy of ONSD, crescent sign and optic disc elevation in identifying increased ICP in pediatrics.
Methods:
Prospective observational study was done between April 2018 and August 2019 after ethics approval. Out of 125 subjects, 40 patients without clinical features of raised ICP were recruited as external controls and 85 with clinical features of raised ICP as study subjects. Their demographic profile, clinical examination and ocular ultrasound findings were noted. This was followed by CT scan. Out of 85 patients, 43 had raised ICP (cases) and 42 had normal ICP (disease controls). Diagnostic accuracy of ONSD in identifying raised ICP was evaluated using STATA.
Results:
The mean ONSD in case group was 5.5±0.6mm, 4.9±0.5mm in disease control group and external control group was 4.8±0.3 mm. Cut-off of ONSD for raised ICP at ≥4.5mm had a sensitivity and specificity of 97.67% and 10.98%, while ≥5.0mm showed a sensitivity and specificity of 86.05% and 71.95%. Crescent sign and optic disc elevation had good correlation with increased ICP.
Conclusion:
ONSD ≥5 mm by POCUS identified raised ICP in pediatric population. Crescent sign and optic disc elevation may function as additional POCUS signs in identifying raised ICP.
... Elevated intracranial pressure (EIP) is a potentially fatal condition caused by a variety of neurological and non-neurological disorders [11]. ONSD ultrasonography has become a common bedside method for detecting increased ICP [12]. ...
... 9 This communication allows CSF to transfer, transmitting the changes between ICP and infraorbital subarachnoid spaces pressure. 10 Objectives This research aimed to evaluate the accuracy of optic nerve sheath diameter (ONSD) in diagnosing and follow-up patients with disturbed conscious levels compared with CT brain and fundus examination. ...
... This technique is recommended in neurosurgery, trauma, critical care, and emergency department. 10 One hundred forty-one participants were included in this study, classified into 76 cases (patients) who were diagnosed with disturbed conscious levels due to elevated ICP and 65 controls. This study showed that ONSD significantly predicts elevated ICP at a cut-off point of average ONSD of 5.19 mm with 97% sensitivity, 98% specificity, and an AUC of 0.996. ...
Background:
Ultrasonographic measurement of optic nerve sheath diameter is a simple, non-invasive, and reliable method of detecting elevated intracranial pressure (ICP) in critical patients. Optic nerve sheath communicates with the dura mater covering the brain and contains cerebrospinal fluid, allowing pressure transmission from the cranium. Therefore, changes in cerebrospinal fluid (CSF) pressure have been shown to produce changes in ONSD.
Objective:
This study aimed to assess the accuracy of optic nerve sheath diameter (ONSD) in diagnosis and follow-up patients with disturbed conscious levels compared with CT brain and fundus examination.
Patients and methods:
One hundred forty-one participants were included in the study, classified into 76 cases admitted with disturbed conscious levels due to elevated ICP and 65 controls. All patients were subjected to CT brain and optic nerve US and fundus examination at the time of admission and follow-up after 48 h after proper management.
Results:
The current study showed that ONSD is significant in predicting elevated ICP at the cut-off point of average ONSD of 5.19 mm with 97% sensitivity and 98% specificity, and the area under the curve (AUC) was 0.996. The present study revealed a significant inverse correlation between ONSD and GCS in patients with increased ICP.
Conclusion:
Ultrasonic measurement of ONSD is a promising technique in diagnosing and following patients with disturbed conscious levels.
... The optic nerve surrounded by a sheath that was in a direct continuation with the meninges so that, Any rise in ICP will cause the optic nerve sheath to dilate with resultant increase in the sheath diameter as a result of increased CSF pressure (6) . ...
... Point-of-care ultrasound (US) assessment of the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) has been widely used to screen for an increased intracranial pressure (ICP). [1][2][3][4] Multiple studies have demonstrated a direct correlation between an enlarged ONSD and elevated ICP in patients with severe head injury, intracranial bleeding, and hemorrhagic stroke or idiopathic intracranial hypertension (IIH), and as a prognostic measure in hypoxic-ischemic encephalopathy after cardiac arrest. [3][4][5][6][7] The correlation of high ICP with an enlarged ONSD can be explained by the continuity of the subarachnoid space into the orbit, surrounding the optic nerve. ...
Background and purpose:
Ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) and optic nerve diameter (OND) is a method frequently used to screen for an increased intracranial pressure. The aim of this study was to assess the accuracy of US measurements of ONSD and OND, when compared to magnetic resonance imaging (MRI) measurements as the criterion standard.
Methods:
In this prospective, single-institution study, orbital US was performed for those patients requiring an emergent brain MRI. ONSD and OND of both eyes were measured in the axial and coronal planes in straight gaze by US. ONSD and OND from brain and orbital MRI were measured by two neuroradiologists. Correlation and agreement between readings were assessed using Pearson's correlations.
Results:
Eighty-two patients met inclusion criteria. The mean axial and coronal ONSD in the MRI examinations was 5.6 and 5.7 mm at 3-5.9 mm behind the globe, respectively. The mean ONSD from the US measurements was 6.22 and 5.52 mm in the axial and coronal planes, respectively. The mean OND in US examinations was 4.31 mm (axial) and 3.68 mm (coronal). Axial versus coronal measurements of ONSD had a modest correlation in US assessment with an r2 of .385 (P < .001) but there were no correlations between any of the US and MRI measurements.
Conclusions:
In measuring ONSD and OND, US measurements showed a modest correlation between axial and coronal measurements, but no concordance was found between US and MRI in our setting.
... Saraf optikus (Nervus II) dibungkus oleh selubung yang berasal dari meningens dan memanjang sampai ke bola mata. 2 Komunikasi antara meningen di dalam kranium dengan selaput mening yang menyelubungi bola mata memungkinkan perpindahan LCS dan perubahan tekanan didalam kranium akan sama dengan ruang subarachnoid di dalam bola mata. 3 Kami melakukan pemeriksaan ONSD pada pasien ini dengan hasil ONSD mata kanan = 5.5 mm, ONSD mata kiri = 6.1 mm (Gambar 5). Laporan kasus kami ini memberikan gambaran bahwa pemeriksaan sonografi bola mata pasien yang dilakukan oleh klinisi ICU dapat memperkirakan tekanan intrakranial pasien secara cepat dan akurat. ...
Latar Belakang: Peningkatan tekanan intrakranial (TIK) adalah kegawatan pada sistem neurologis yang dapat menyebabkan kematian, akibat keganasan di otak, cedera kepala tertutup, gangguan aliran liquor cerebro spinal (LCS), sumbatan pada sinus venosus utama dan yang bersifat idiopatik. Berbagai penelitian menunjukkan bahwa monitoring TIK dapat meningkatkan kualitas dan kelangsungan hidup pasien-pasien yang mengalami peningkatan TIK. Metode pengukuran TIK non invasif seperti pengukuran optical nerve sheath diameter (ONSD) jarang dilakukan di Indonesia meskipun memiliki nilai manfaat yang besar bagi penatalaksanaan pasien di ICU.Kasus: Kami melaporkan 4 kasus ICU di RSUD Dr. Moewardi, Solo, Jawa Tengah: laki-laki, 54 tahun dengan cedera kepala berat (CKB), ICH regio temporal dan edema cerebri, mendapatkan terapi konservatif; wanita 52 tahun, dengan CKB, SDH regio frontotempororoparietal, ICH regio temporoparietal dekstra dan edema cerebri; wanita 44 tahun mengalami cedera kepala akibat kecelakaan lalu lintas dengan EDH regio parietotemporal dextra, closed fracture clavicula dextra dan dilakukan kraniotomi evakuasi EDH; laki-laki 45 tahun dengan stroke hemoragik,dekstra, patah tulang tertutup, klavikula kanan dan dilakukan evakuasi EDH pascaoperasi ICH. Pada keempat pasien di atas kami lakukan pengukuran ONSD pada kedua bola mata dengan hasil yang berbeda-beda. ONSD > 5 mm kami anggap pasien mengalami peningkatan TIK, TIK > 20 mmHg, dan terapi di ICU disesuaikan dengan hasil ini untuk menurunkan TIK nya.Pembahasan: Laporan kasus kami ini memberikan gambaran bahwa pemeriksaan sonografi bola mata pasien yang dilakukan oleh klinisi ICU dapat memperkirakan tekanan intrakranial pasien secara cepat dan akurat. ONSD dengan cut off > 5 mm dapat memperkirakan TIK > 20 mmHg. Pada pasien kasus 1, 2, 4 didapatkan ONSD melebihi 5 mm pada kedua bola mata dan TIK diperkirakan melebihi 20 mmHg. Segala terapi yang bertujuan menurunkan TIK telah dilakukan kecuali kraniotomi dekompresi pada 2 pasien (kasus 1, dan kasus 2). Pemeriksaan ONSD juga memberikan informasi kepada klinisi tentang prognosis pasien. Hal ini menjadi penting saat memberikan informasi kepada keluarga pasien dan untuk rencana terapi selanjutnya. Pengukuran ONSD akan sangat bermanfaat dalam merubah keluaran pasien jika diukur pada fase awal dan dapat merubah terapi sesuai hasil ONSD. Pemeriksaan ONSD juga memeiliki keterbatasan yaitu sangat tergantung pada kemampuan operator sonografinya.Kesimpulan: Ini adalah laporan pertama di unit perawatan intensif kami berkenaan dengan metode pengukuran TIK non invasif. Diperlukan penelitian prospektif mengenai akurasi hasil antara pemeriksa, dan kegunaannya pada fase awal pasien cidera kepala (di ruang resusitasi) atau pasien yang beresiko mengalami peningkatan TIK.
... Young age, developmental status, anxiety, and fear can cause a child to be noncooperative and severely limit the reliability of the fundoscopic examination. Ocular point-of-care ultrasound (POCUS) has been used as a diagnostic adjunct for traumatic conditions, malignancies, inflammatory pathologies, and infections involving the ocular globe and its surrounding structures [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] in both children and adults. The fluid-filled globe provides an excellent acoustic window for sound wave transmission and produces high-quality images ( Fig. 1). ...
... Point-of-care ultrasound is now commonly used in emergency medicine and becoming more available in the pediatric ED, where its use has been supported by the American Academy of Pediatrics since 2015. 19 This disruptive technology has been used to improve the diagnosis and management of a variety of ocular conditions, including traumatic injuries, 1-8 foreign bodies, 9,10 infections, 11 malignancies, 12,13 elevated intracranial pressure, [14][15][16] ventriculoperitoneal shunt obstruction, 17 and optic neuritis. 15,18 Despite reports of successful use in children of all ages (including infants and toddlers) 1,15,17 ocular POCUS remains an underdeveloped application in pediatrics. ...
Objective:
Point-of-care ultrasound has become an important adjunct for diagnostic assessment in pediatric emergency medicine. In this case series, we demonstrate how ocular point-of-care ultrasound is used to correctly diagnose ocular pathologies and to expedite care.
Methods/results:
We present a series of cases in which the point-of-care ultrasound ocular examination proved valuable in the timely diagnosis of pathologies involving the lens, vitreous, retina, and retrobulbar segment of the eye.
Conclusion:
Point-of-care ultrasound may facilitate diagnosis in children with ocular complaints, even in young and uncooperative patients, and should be considered in children of all ages.
... A prospective study done in the Intensive Care Unit (ICU) with intracranial pressure monitoring showed a strong correlation between the optic nerve sheath diameter (over 5 mm) and the ICP (greater than 20 cms H20) [12]. Thus, it was considered that the optic nerve sheath measuring through ocular ultrasonography is a useful method, since it is noninvasive and dynamic in patients with IIH, which allows reducing the inherent complications related to invasive methods [7,13,14]. ...
... In the last decades the ultrasonography has proved to be a useful tool for many pathologies that require a proper diagnosis and handling in the emergency service [13]. The American College of Emergency Physicians (ACEP) has considered the use of bedside emergency ultrasound as a vital aspect in the visual exam of the patients, being applicable in patients with suspected retinal detachment initially [12]. ...
The measurement of the optic nerve sheath by ocular ultrasonography might be an indirect method to assess the quickly increase of the intracranial pressure in patients with moderate trauma brain injury, taking into account that an important proportion of these could develop the increase of the intracranial pressure in a hospital-acquired way. Therefore noninvasive, reliable, and convenient techniques are needed making the ocular ultrasonography a useful tool, due to the invasive monitoring elements’ problems and the poor access to measure the intracranial pressure in emergency services. In spite of the limitations and few studies that exist to consider it as a possible early detection, this technique could work as a noninvasive one in the case that could not be possible to do invasive monitoring or when it is not recommended.
... Although patients with suspected IIH would undoubtedly benefit from a funduscopic evaluation, recent studies have proven that a bedside ocular sonogram is an acceptable option when a funduscopic evaluation is not readily available [7]. Head Computed Tomography scan (CT) and a brain Magnetic Resonance Imaging (MRI) can be used for evaluating IIH as well, where an empty Sella turcica has been described in both imaging studies, which possess a sensitivity of 65.9% and a specificity of 100% [8]. There are other findings in MRI that have been set out as possible IIH markers, which include posterior globe flattening, vertical tortuosity of the optic nerve, optic nerve sheath distention and increased foramen ovale size, where there's a stipulated sensitivity fluctuating from 50-65% and a specificity of 100% [8]. ...
... Head Computed Tomography scan (CT) and a brain Magnetic Resonance Imaging (MRI) can be used for evaluating IIH as well, where an empty Sella turcica has been described in both imaging studies, which possess a sensitivity of 65.9% and a specificity of 100% [8]. There are other findings in MRI that have been set out as possible IIH markers, which include posterior globe flattening, vertical tortuosity of the optic nerve, optic nerve sheath distention and increased foramen ovale size, where there's a stipulated sensitivity fluctuating from 50-65% and a specificity of 100% [8]. ...
... Aproximadamente, desde 1980 el ultrasonido ha ayudado a los clínicos para el diagnóstico de gran cantidad de enfermedades críticas, entre ellas oculares y desde entonces se ha venido actualizando su uso, incluyendo la medición de la PIC a través del diámetro de la envoltura del nervio óptico (18,22). La envoltura del nervio óptico se une al globo ocular en su parte posterior; ésta es contigua a la duramadre y tiene el espacio subaracnoideo por donde el líquido cefalorraquídeo se filtra. ...
... al y Maissan et. al cuando realizaron, respectivamente, estudios prospectivos con pacientes a los que se les monitoreaba la PIC (18,19,21,22,26). ...
